双膦酸盐治疗绝经后骨质疏松的系统评价再评价

An overview of systematic reviews of bisphosphonates in the treatment of postmenopausal osteoporosis

目的系统评价再评价并对比双膦酸盐治疗绝经后骨质疏松的有效性。方法计算机检索Cochrane Library、Pub Med、SCI、中国知网(CNKI)、维普数据库(VIP)、中国生物医学文献数据库(CBM)及万方数据库,并进行手工检索,筛选符合的双膦酸盐治疗绝经后骨质疏松的系统评价,用AMSTAR量表评价文献质量,用Rev Man5.3软件进行Meta分析,再用间接比较方法进行结果分析。结果纳入12篇系统评价,共6种双膦酸盐药物(唑来膦酸、依替膦酸、阿仑膦酸、伊班膦酸、利噻膦酸和帕米膦酸)。纳入文献的AMSTAR量表质量评分均较高。Meta分析结果显示,5种双膦酸盐(帕米膦酸除外)治疗绝经后骨质疏松疗效显著。间接比较结果显示,唑来膦酸与安慰剂、利噻膦酸、伊班膦酸、阿仑膦酸、依替膦酸比较,降低椎骨骨折发生率的相对危险度(RR)分别为0.31,0.49,0.53,0.57,0.74;唑来膦酸与安慰剂、利噻膦酸、伊班膦酸、阿仑膦酸、依替膦酸比较,降低非椎骨骨折发生率的RR值分别为0.72,0.71,0.89,0.87,0.90。结论唑来膦酸在这5种双膦酸盐中治疗绝经后骨质疏松的疗效最好。

Objective To evaluate the efficacy of bisphosphonate therapies regarding the treatment of vertebraland non vertebral-non hip fractures in postmenopausal women with osteoporosis. Methods We searched systematic reviews on the databases in Cochrane Library,Pub Med,SCI,CNKI,VIP,CBM and Wangfang database,as well as hand searching. The reviews were identified with a systematic literature search. Then the data were extracted by standardized forms,and the methodological qualities of the reviews were assessed by the AMSTAR tool. The endpoints of interest were vertebral and non-vertebral fractures. The Meta-analysis was evaluated by Rev Man 5. 3 software. Results of all reviews were analyzed byindirect comparison. Results A total of 12 systematic reviews were included. There were six bisphophonates in these reviews（ including alendronate,ibandrinate,etidronate,risedronate,pamidronate,and zoledronic acid）. All the reviews were in high quality. The results of Meta-analysis showed that there was statistically significant by five bisphosphonates,expect for pamidronate. So there were five bisphosphonates（ alendronate,ibandrinate,etidronate,risedronate,and zoledronic acid） analyzed with indirect comparion. In vertebral fractures of all bisphophonates compared, zoledronic acidshowed a relative risk（ RR） of 0. 49 relative to placebo,and RRs were 0. 49,0. 53,0. 51,0. 74 relative to risedronate,ibandronate,alendronate,etidronate. Regarding non-vertebral fractures,RRs of zoledronic acid relative to placebo,risedronate,alendronate,ibandronate,etidronate were 0. 72,0. 71,0. 87,0. 89,and 0. 90,respectively.Risedronate showed the greatest reduction in any fractures,followed by zoledronic acid. Conclusion In summary,zoledronic acid has the best effectiveness on the treatment of osteoporosis among the five bisphosphonate.