利塞膦酸盐影响原发性绝经后骨质疏松性骨折发生率的Meta分析

Incidence of fracture after risedronate for the treatment of primary postmenopausal osteoporosis:a meta analysis

[目的]系统评价利塞膦酸盐影响原发性绝经后骨质疏松性骨折发生率的有效性和安全性。[方法]按照Cochrane协作网制订的检索策略进行检索,计算机检索MEDLINE(1966～2010年12月)、EMBASE(1974～2010年12月)、Cochrane图书馆(2010年第12期)、中国生物医学文献数据库(CBM,1978～2010年12月)、中国期刊全文数据库(CNKI,1994～2010年12月)、中文科技期刊全文数据库(VIP,1989～2010年12月)及万方数据库(1979～2010年12月)。手工检索相关的中英文骨科杂志和会议论文。纳入利塞膦酸盐影响原发性绝经后骨质疏松性骨折发生率的所有随机对照试验,由2名评价员独立提取资料,并对其方法学质量进行评价。对符合纳入标准的研究用RevMan 5.0软件进行Meta分析。[结果]共纳入7个随机对照试验。10 359例患者。Meta分析结果显示:利塞膦酸盐可以降低原发性绝经后骨质疏松性椎体骨折发生率[RR=0.66,95%CI(0.57,0.77)P<0.000 01];利塞膦酸盐可以降低原发性绝经后骨质疏松性非椎体骨折发生率[RR=0.69,95%CI(0.52,0.90)P=0.007];利塞膦酸盐可以降低原发性绝经后骨质疏松性髋部骨折发生率[RR=0.66,95%CI(0.49,0.90)P=0.008]。[结论]利塞膦酸盐有利于降低原发性绝经后骨质疏松性骨折的发生率,但限于纳入研究在方法学方面的局限性,尚需开展大样本、高质量的RCT进一步论证其疗效和安全性。

[Objective] To assess the efficacy and safety of the incidence of fracture after risedronate for the treatment of primary postmenopausal osteoporosis.[Method]We searched the Cochrane Central Register of Controlled Trials（CENTRAL）（Issue 12,2010）,MEDLINE,EMBASE,CBM,CNKI,VIP,Wanfang database,etc.from their inception to December 2010.Some relevant journals were handsearched as well.Two reviewers independently evaluated the quality of included studies and extracted the data.Meta-analysis was performed by RevMan5.0 software.[Result]Seven randomized controlled trials（RCTs） involving 10359 patients were included.Risedronate can decrease the incidence of vertebral fracture,non-vertebral fracture and hip fracture（P0.05）.[Conclusion]Risedronate decreases the incidence of fracture after risedronate for the treatment of primary postmenopausal osteoporosis.However,there is a moderate possibility of selection bias,performance bias and publication bias in this review because of the small number of the included studies,which weakens the strength of the evidence of our results.More large sample size,high-quality RCTs are needed.