Laboratory of Social Pharmacy and Public Health, Faculty of Pharmacy, Polo Ciencias da Saude, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548, Coimbra, Portugal.
Clevidence, Lda., Taguspark, Oeiras, Portugal.
Int J Clin Pharm. 2024 Apr;46(2):357-367. doi: 10.1007/s11096-023-01666-x. Epub 2023 Dec 19.
Ibandronate is effective in reducing the risk of vertebral fractures, but experimental evidence offers conflicting results regarding nonvertebral fractures. Real-world evidence has been published evaluating the anti-nonvertebral fracture effect of ibandronate.
This meta-analysis of observational studies assessed the effectiveness of ibandronate in reducing the risk of nonvertebral fractures in women with osteoporosis.
Pubmed/Embase databases were searched for observational studies. Risks of nonvertebral fractures and hip fractures were the outcomes. Meta-analyses were performed pooling rate ratios (RRs), using random-effects models. Data were reanalysed in sensitivity analyses considering Knapp-Hartung method and Bayesian random-effects.
Six cohort studies were included. Overall, once-monthly 150 mg oral ibandronate reduced the risk of nonvertebral fractures (RR 0.84; 95% CI 0.76-0.94). Similar results were obtained when the comparison was restricted to once-monthly 150 mg risedronate, but no differences were found when the comparator was other oral bisphosphonates (weekly alendronate/risedronate). Ibandronate didn't significantly change the risk of hip fractures (RR 1.25; 95% CI 0.89-1.76). The risk of hip fracture was comparable between once monthly, 150 mg oral ibandronate and other oral bisphosphonates. Intravenous ibandronate was not effective in reducing hip fractures comparing to intravenous zoledronate. The low number of studies diminished the robustness of sensitivity analyses.
Results suggest that once-monthly 150 mg oral ibandronate may be as effective as other oral bisphosphonates in reducing the risk of nonvertebral fractures. However, uncertainty associated to the small number of included studies, which are characterized by heterogeneous demographics and methodologies, precluded definitive conclusions.
伊班膦酸盐可有效降低椎体骨折风险，但有关非椎体骨折的实验证据结果相互矛盾。已有研究发表了评估伊班膦酸盐预防非椎体骨折效果的真实世界证据。
本项针对观察性研究的荟萃分析评估了伊班膦酸盐在降低骨质疏松症女性发生非椎体骨折风险中的有效性。
在 Pubmed/Embase 数据库中检索观察性研究。非椎体骨折和髋部骨折风险为结局指标。使用随机效应模型对率比（RR）进行荟萃分析。在考虑 Knapp-Hartung 法和贝叶斯随机效应的敏感性分析中重新分析数据。
共纳入 6 项队列研究。总体而言，每月 150mg 口服伊班膦酸盐可降低非椎体骨折风险（RR 0.84；95%CI 0.76-0.94）。当比较仅为每月 150mg 利塞膦酸钠时，也得到了相似的结果，但当比较药物为其他口服双膦酸盐（每周阿伦膦酸钠/利塞膦酸钠）时，则无差异。伊班膦酸盐并未显著改变髋部骨折风险（RR 1.25；95%CI 0.89-1.76）。每月 1 次、150mg 口服伊班膦酸盐与其他口服双膦酸盐之间的髋部骨折风险相当。与静脉用唑来膦酸相比，静脉用伊班膦酸盐在降低髋部骨折风险方面无效。由于纳入研究数量较少，敏感性分析的稳健性降低。
结果表明，每月 150mg 口服伊班膦酸盐在降低非椎体骨折风险方面可能与其他口服双膦酸盐一样有效。然而，由于纳入研究数量较少，且研究在人口统计学和方法学方面存在异质性，因此无法得出明确的结论。
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