应用阿仑膦酸3~4年对社区绝经后女性脆性骨折发生率影响的Meta分析

目的:系统评价应用阿仑膦酸3~4年预防脆性骨折的结果。方法:系统搜索MED-LINE、EMBASE、CENTRAL和中国生物医学文献数据库及相关研究的引文。时间范围建库至2020年7月16日。使用Cochrane偏倚风险评估工具进行质量评估。根据异质性大小决定使用固定或随机效应模型。对高风险研究进行敏感性分析。按照PR...

Alendronate use for 3 to 4 years reduces incidence of fragile fractures in community postmenopausal women: a meta-analysis

Objective To evaluate systematically the outcomes of prevention of fragility fracture with alendronate use for 3 to 4 years.Methods We searched CENTRAL,MEDLINE,EMBASE and CBM for relevant randomized controlled trials published before 16 July,2020.The quality of included studies was evaluated according to the Cochrane tool for assessing risk of bias.Fix-or random-effects were taken for meta-analysis depending on the magnitude of heterogeneity.Sensitivity analysis was used for high risk studies to assess the robustness of results.The results were reported according to The PRISMA 2009 Check-list.Results A total of 8 reports from 4 studies were included.Two reports from 2 studies were rated as high-risk while the other 6 reports from the other 2 studies as low-risk.The meta-analyses showed that use of alendronic acid for 3 to 4 years effectively prevented new vertebral fracture(RR=0.54,95%CI:0.44 to 0.66,RD=-0.03),clinical fracture(RR=0.82,95%CI:0.73 to 0.92,RD=-0.03),non-vertebral fracture(RR=0.84,95%CI:0.75 to 0.95,RD=-0.02),clinical vertebral fracture(RR=0.51,95%CI:0.34 to 0.76,RD=-0.01)and hip fracture(RR=0.56,95%CI:0.37 to 0.87,RD=-0.01),but did not prevent wrist fracture(RR=0.85,95%CI:0.67 to 1.09),serious adverse event(RR=0.95,95%CI:0.80 to 1.14)or upper gastrointestinal adverse event(RR=1.02,95%CI:0.96 to 1.07).By the sensitivity analysis of the 6 results from the high-risk reports,the HRs for clinical fracture,non-vertebral fracture,vertebral fracture,hip fracture,wrist fracture,and serious adverse event were,respectively,0.81,0.85,0.49,0.62,0.94 and 0.94.Conclusions Alendronate use for 3 to 4 years can effectively prevent fragility fractures in postmenopausal women with low bone mass or osteoporosis,leading to better prevention effect on vertebral fracture than on non-vertebral fracture.