Yang Yuangui, Yang Mingyue, Su Xuanyi, Xie Feibin
School of Clinical Medicine, Xiamen University, Xiamen, China.
School of Clinical Medicine, Fujian Medical University, Fuzhou, China.
Front Pharmacol. 2024 Nov 21;15:1422062. doi: 10.3389/fphar.2024.1422062. eCollection 2024.
There is currently no consensus on whether the combination therapy of Vitamin D (VitD) and bisphosphonates offers superior efficacy compared to monotherapy in the treatment of postmenopausal osteoporosis. The aim of this study is to conduct a meta-analysis of recent relevant research to synthesize the available evidence and further investigate whether the combined use of VitD and bisphosphonates is superior to monotherapy in treating osteoporosis in postmenopausal women.
We systematically searched PubMed, EMBASE, the Cochrane Library, and Web of Science for randomized controlled trials (RCTs) comparing the effects of monotherapy with VitD or bisphosphonates their combination therapy in the treatment of postmenopausal osteoporosis, up to 1 February 2024. The articles were independently screened and relevant data were extracted by two investigators. The changes in mean values and percentage changes for bone resorption markers, bone formation markers, bone mineral density, and bone mineral metabolism markers were expressed using the standardized mean difference (SMD) and 95% confidence intervals (CI). Heterogeneity was quantitatively described using the I test. Subsequently, sensitivity analyses were performed for data with significant heterogeneity. Subgroup analyses were conducted based on the type of monotherapy used, and potential publication bias was assessed. The analysis revealed that the combination of VitD and bisphosphonates demonstrated a more pronounced effect in increasing alkaline phosphatase (ALP), 25-hydroxyvitamin D (25-OH-VD), and serum calcium (sCa) levels, as well as in decreasing levels of serum bone-specific alkaline phosphatase (sBALP), serum C-terminal telopeptide of type I collagen (sCTX), and urinary N-telopeptide of type I collagen (UriNTX) compared to the monotherapy group. However, the combination of VitD and bisphosphonates did not show a significant advantage over monotherapy in terms of improving osteocalcin levels. The differences in the mean changes in osteocalcin, UriNTX, and sCa, as well as the percentage changes in parathyroid hormone (PTH) were not statistically significant ( > 0.05).
The meta-analysis suggests that compared to monotherapy, the combination therapy of VitD and bisphosphonates exhibits a more favorable effect on bone mineral density and bone calcium metabolism-related markers in the treatment of postmenopausal osteoporosis.
目前，维生素D（VitD）与双膦酸盐联合治疗与单一疗法相比，在绝经后骨质疏松症治疗中是否具有更高疗效尚无共识。本研究的目的是对近期相关研究进行荟萃分析，以综合现有证据，并进一步研究VitD与双膦酸盐联合使用在治疗绝经后女性骨质疏松症方面是否优于单一疗法。
我们系统检索了PubMed、EMBASE、Cochrane图书馆和Web of Science，以查找比较VitD或双膦酸盐单一疗法及其联合疗法在治疗绝经后骨质疏松症方面效果的随机对照试验（RCT），检索截至2024年2月1日。文章由两名研究人员独立筛选并提取相关数据。骨吸收标志物、骨形成标志物、骨密度和骨矿物质代谢标志物的均值变化和百分比变化采用标准化均值差（SMD）和95%置信区间（CI）表示。使用I²检验对异质性进行定量描述。随后，对具有显著异质性的数据进行敏感性分析。根据所用单一疗法的类型进行亚组分析，并评估潜在的发表偏倚。分析显示，与单一疗法组相比，VitD与双膦酸盐联合使用在提高碱性磷酸酶（ALP）、25-羟基维生素D（25-OH-VD）和血清钙（sCa）水平，以及降低血清骨特异性碱性磷酸酶（sBALP）、血清I型胶原C末端肽（sCTX）和尿I型胶原N末端肽（UriNTX）水平方面表现出更显著的效果。然而，在改善骨钙素水平方面，VitD与双膦酸盐联合使用并未显示出比单一疗法有显著优势。骨钙素、UriNTX和sCa的平均变化差异，以及甲状旁腺激素（PTH）的百分比变化差异均无统计学意义（P>0.05）。
荟萃分析表明，与单一疗法相比，VitD与双膦酸盐联合疗法在治疗绝经后骨质疏松症时，对骨密度和骨钙代谢相关标志物表现出更有利的影响。
