唑来膦酸治疗绝经后骨质疏松的Meta分析

目的系统评价唑来膦酸治疗绝经后骨质疏松症的疗效和安全性。方法系统检索CNKI、CBM、VIP、Wan Fang、PubMed、Embase、Cochrane图书馆,对关于唑来膦酸治疗绝经后骨质疏松的临床随机对照研究(RCT),纳入研究开展方法学质量评估,同时借助软件Stata 16.0和Review Manager 5.3进行疗效和安全性的系统评价。结果所纳入文献量合计10篇,涉及研究为16个,包括1 277例患者。结果表明唑来膦酸联合钙剂能有效提高绝经后骨质疏松患者的腰椎骨密度MD=0.021,95%CI(0.009,0.033),P0.05]。并对腰椎BMD进行亚组分析,表明治疗方法亚组分析中,唑来膦酸联合钙剂的疗效最好MD=0.037,95%CI(0.009,0.065),P=0.009];按照疗程分组,疗程小于1年的疗效相对较差MD=0.017,95%CI(-0.034,0.069),P=0.506];按患者所在国家分组,中国MD=0.02,95%CI (0.006,0.035),P=0.005]和印度MD=0.03,95%CI(0.002,0.058),P=0.005]疗效好。网状Meta分析结果表明唑来膦酸联合钙剂对于提高腰椎BMD的效果最好。唑来膦酸治疗普通不良反应(流感样症状、发热、头痛、肌痛及关节痛、骨折等)较少,更极少发生严重不良反应。结论唑来膦酸联合钙剂对绝经后骨质疏松的治疗具有积极意义,显著改善了患者的骨密度;降低血清生化标志物;不良反应发生率较低,安全性高。

Meta-analysis of zoledronic acid in the treatment of postmenopausal osteoporosis

Objective To retrospective analyze the efficacy and safety of zoledronic acid in the treatment of postmenopausal osteoporosis. Methods The clinical randomized control studies (RCT) on the treatment of post-menopausal osteoporosis with pyrethroid acid were systematically retrieved from CNKI, CBM, PubMed, VIP, Embase, WanFang, and Cochrane Library. The study methodological quality assessment was conducted. The efficacy and safety were evaluated with software Stata16.0 and Review Manager 5.3. Results A total of 10 articles were included, involving 16 studies and 1277 patients. The results showed that zoledronic acid combined with calcium was effective in improving the bone mineral density (BMD) of the lumbar vertebrae in patients with post-menopausal osteoporosis (MD=0.021, 95%CI 0.009, 0.033, P>0.05). A subgroup analysis of lumbar spine BMD showed that in the subgroup analysis of treatment methods, zoledronic acid combined with calcium had the best effect (MD=0.037, 95%CI 0.009, 0.065, P=0.009). According to the grouping of treatment courses, the efficacy of treatment course less than 1 year is relatively low (MD=0.017, 95%CI -0.034, 0.069, P=0.506). When grouped by the country where the patients were located, China (MD=0.02, 95%CI 0.006, 0.035, P=0.005) and India (MD=0.03, 95%CI 0.002, 0.058, P=0.005) were the most effective. Network Meta results showed that zoledronic acid combined with calcium was the best for improving lumbar spine BMD. Zoledronic acid treatment rarely had serious adverse reactions, and the incidence of common adverse reactions (fever, myalgia, flu-like symptoms, headache, arthralgia, fractures, etc.) was low. Conclusion The combination of zoledronic acid has positive significance for the treatment of postmenopausal osteoporosis by significantly improving BMD of the patients and reducing serum biochemical markers. The incidence of adverse reactions is low and the safety is high.