激素替代联合二磷酸盐预防和治疗绝经后骨质疏松症疗效的系统评价

目的 评价联合与单一用激素替代和二磷酸盐预防和治疗绝经后骨质疏松的疗效性和安全性.方法 计算机检索MEDLINE(1966～2008.10)、Embase(1984～2005)、PubMed(1966～2008.10)、Cocharane图书馆(CENTRAL 2008年第三期)、中国生物医学文献光盘数据库(1978～2006年)和中国期刊全文数据(1979～2008.10),并手工检索相关领域其他杂志.对纳入文献进行质量评价.数据分析采用RevMan 5.0,对于异质性小的研究合并效应量.结果 共纳入13 个随机对照试验,包括3341 例患者.Meta 分析结果显示:①联合治疗组与二磷酸盐单一用药组比较,在增加腰椎骨密度和减少骨折风险方面无明显差别,在降低骨转化标志物及药物副作用方面无优势.②联合治疗组与激素替代单一治疗组比较,在增加腰椎骨密度、药物副作用方面具有明显优势,在减少骨折风险、降低骨转化标志物方面无明显差别.结论 激素替代联合二磷酸盐预防和治疗绝经后骨质疏松症疗效优于激素替代单一治疗,但与二磷酸盐单一治疗比较并没有优势,且副作用明显增加.

Hormone replacement therapy combined with bisphosphonate for the prevention and treatment of postmenopausal osteoporosis: A systematic review

Objective To assess the efficacy and safety of hormone replacement therapy(HRT)combined with bisphosphonates(BPS) on bone mineraldensity (BMD)、fractures、Biochemical markers of bone turnover、Adverse events (AEs) in postmenopausal women with osteoporosis. Methods We searched MEDLINE (1966 to October 2008), EMBASE (1984 to 2008), PubMed(1966 to October 2008), The Cochrane Library (CENTRAL Issue Ⅲ, 2008), CBM (1978 to 2006), CNKI (1979 to October 2008).Some related journals were hand searched as well. The quality of included randomized controlled trials (RCTs) was evaluated and meta-analysis was conducted by The Cochrane Collaborations software RevMan5.0. Results Thirteen studies involving 3341 patients were included. ①Compared with combined therapy with bisphosphonate group, there were no significant difference between increased spine BMD and reduced the risk of vertebral fracture,but combined therapy was less reduced levels of biochemical markers of bone turnover and risk of AEs than bisphosphonate group. ②There were significant difference between increased spine BMD and reduced risk of AEs in combined therapy and HRT,but no significant difference between reduced the risk of vertebral fracture and reduced levels of biochemical markers of bone turnover. Conclusion Hormone replacement therapy combined with bisphosphonate is effective in the prevention and treatment of postmenopausal osteoporosis,it is better increasing spine BMD, and is less AEs than HRT.But compared with bisphosphonate group, there are no advantage in combination therapy, in particular, a significant increasing in AEs.