School of Medicine, The University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
Cardiovascular Division, The George Institute for Global Health, Newtown, New South Wales, Australia.
BMJ Open. 2024 Sep 25;14(9):e084516. doi: 10.1136/bmjopen-2024-084516.
To determine whether bisphosphonates and NF-κB ligand (RANKL) inhibitors delay coronary artery calcification (CAC).
A systematic review was conducted.
MEDLINE, EMBASE and CENTRAL.
Longitudinal studies investigating CAC progression in adults (>18 years) taking either a bisphosphonate or denosumab compared with those who did not.
Study and participant characteristics, and primary outcome ( ∆ CAC from baseline to follow-up) were extracted. The Risk Of Bias In Non-Randomised Studies-of Interventions (ROBINS-I) and Risk-of-Bias Tool for Randomised Trials (RoB2) tools were used to assess the risk of bias for observational and randomised controlled trials (RCTs), respectively. Outcome measures were reported.
Four observational studies and one RCT (n=377) were included. Three studies solely reported the effect of bisphosphonates on ∆ CAC; one study (n=56) demonstrated a statistically significant CAC reduction in the intervention group (-372 mm/year) compared with control (+159 mm/year) (p<0.01). One study (n=14) demonstrated a difference in ∆ CAC between intervention (+880 mm/year) versus control (+2220 mm/year), however, no p value comparing groups was reported. One study (n=115) found no statistically significant difference between intervention and control.One study (n=42) exclusively investigated the effect of RANKL on ∆ CAC; there was a statistically significant reduction in CAC at 6-month follow-up between intervention (-133±124 modified Agatston unit (AU)) and control (+188±72 modified AU), p=0.03.One study (n=150) compared both bisphosphonates and denosumab to control and found no statistically significant difference between either intervention group and control over 24 months. Meta-analysis was not performed due to limited, heterogeneous studies.
There is insufficient evidence supporting the correlation between bisphosphonate or RANKL inhibitor use and CAC progression. Further research is warranted.
确定双膦酸盐和 NF-κB 配体（RANKL）抑制剂是否延迟冠状动脉钙化（CAC）。
系统评价。
MEDLINE、EMBASE 和 CENTRAL。
对接受双膦酸盐或地舒单抗治疗的成年人（>18 岁）与未接受治疗者进行 CAC 进展的纵向研究。
提取研究和参与者特征以及主要结局（从基线到随访的 CAC 变化）。使用非随机干预研究的风险偏倚（ROBINS-I）和随机对照试验风险偏倚工具（RoB2）工具分别评估观察性和随机对照试验（RCT）的风险偏倚。报告了结局测量值。
共纳入 4 项观察性研究和 1 项 RCT（n=377）。3 项研究仅报告了双膦酸盐对 ∆CAC 的影响；1 项研究（n=56）显示干预组 CAC 减少幅度具有统计学意义（-372mm/年），而对照组（+159mm/年）（p<0.01）。1 项研究（n=14）显示干预组（+880mm/年）与对照组（+2220mm/年）之间的 ∆CAC 存在差异，但未报告组间比较的 p 值。1 项研究（n=115）发现干预组和对照组之间的差异无统计学意义。1 项研究（n=42）专门研究了 RANKL 对 ∆CAC 的影响；在 6 个月随访时，干预组 CAC 减少幅度具有统计学意义（-133±124 改良 Agatston 单位（AU）），对照组（+188±72 改良 AU），p=0.03。1 项研究（n=150）比较了双膦酸盐和地舒单抗与对照组，发现 24 个月内任何干预组与对照组之间均无统计学差异。由于研究数量有限且存在异质性，因此未进行荟萃分析。
目前尚无充分证据支持双膦酸盐或 RANKL 抑制剂的使用与 CAC 进展之间存在相关性。需要进一步研究。
