Intervention Review

Bisphosphonates for steroid induced osteoporosis

  1. Joanne Homik1,*,
  2. Ann Cranney2,
  3. Beverley Shea3,
  4. Peter Tugwell4,
  5. George A Wells5,
  6. Jonathan Adachi6,
  7. Maria E Suarez-Almazor7

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 25 JAN 1999

Assessed as up-to-date: 16 NOV 1998

DOI: 10.1002/14651858.CD001347


How to Cite

Homik J, Cranney A, Shea B, Tugwell P, Wells GA, Adachi J, Suarez-Almazor ME. Bisphosphonates for steroid induced osteoporosis. Cochrane Database of Systematic Reviews 1999, Issue 1. Art. No.: CD001347. DOI: 10.1002/14651858.CD001347.

Author Information

  1. 1

    University of Alberta, Deparment of Medicine, Edmonton, Alberta, Canada

  2. 2

    Ottawa Hospital, Division of Rheumatology, Ottawa, Ontario, Canada

  3. 3

    University of Ottawa, Institute of Population Health, Ottawa, Ontario, Canada

  4. 4

    Ottawa Hospital, Centre for Global Health, Institute of Population Health, Department of Medicine, Ottawa, Ontario, Canada

  5. 5

    University of Ottawa Heart Institute, Cardiovascular Research Reference Centre, Ottawa, Ontario, Canada

  6. 6

    St Joseph's Hospital, Hamilton, Ontario, Canada

  7. 7

    The University of Texas, M.D. Anderson Cancer Center, General Internal Medicine, Ambulatory Treatment and Emergency Care, Houston, Texas, USA

*Joanne Homik, Deparment of Medicine, University of Alberta, 562 Heritage Medical Research Centre, Edmonton, Alberta, T6G 2S2, Canada. joanne.homik@ualberta.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 25 JAN 1999

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Corticosteroids are widely used in inflammatory conditions as an immunosuppressive agent. Diseases treated with corticosteroids include connective tissue diseases, asthma, inflammatory bowel disease and organ transplantation. Bone loss is a serious side effect of this therapy. Several studies have examined the use of bisphosphonates as a treatment for corticosteroid-induced osteoporosis and have reported varying magnitudes of effect. The best estimate of the magnitude of efficacy regarding bisphosphonate prevention of corticosteroid-induced bone loss is needed, before their use is advocated.

Objectives

To assess the effects of bisphosphonates for the prevention and treatment of corticosteroid-induced osteoporosis.

Search methods

We searched the Cochrane Musculoskeletal Group trials register, MEDLINE up to 1997 and EMBASE 1988-1997), and selected hand searching of reference lists was conducted. Hand searching of scientific abstracts from relevant meetings for the last five years was also done. An electronic search in Current Contents was done for the last six months. The Cochrane Controlled Trials Register (CCTR) will be searched for future updates.

All languages were included in the search. For practical reasons only those in English were included, but all languages will be retrieved and translated for future updates.

Selection criteria

All controlled clinical trials (CCTs) dealing with prevention or treatment of corticosteroid-induced osteoporosis with bisphosphonates of any type and reporting the outcomes of interest were assessed. Trials had to involve adults only, and subjects had to be taking a mean steroid dose of 7.5 mg/day or more.

Data collection and analysis

All data extraction was performed by two independent reviewers. Outcomes of interest included change in bone mineral density (BMD) at the lumbar spine and femoral neck at six and 12 months. If present, data on number of new fractures and withdrawals due to adverse effects were also extracted. All data extraction was performed by two independent reviewers.
Both continuous and dichotomous data were analyzed using fixed effects models. When significant heterogeneity was present, a random effects model was used.

Main results

A total of 13 trials, including 842 patients are included in this meta-analysis. Results are reported as a weighted mean difference of the percent change in BMD between the treatment and placebo groups, with trials being weighted by the inverse of their variance. The 95% confidence intervals (95% CI) are presented. At the lumbar spine, the weighted mean difference of BMD between the treatment and placebo groups was 4.3% (95% CI 2.7, 5.9). At the femoral neck, the weighted mean difference was 2.1% (95%CI 0.01, 3.8). Although there was a 24% reduction in odds of spinal fractures [OR 0.76 (95%CI 0.37, 1.53)], this result was not statistically significant.

Authors' conclusions

Bisphosphonates are effective at preventing and treating corticosteroid-induced bone loss at the lumbar spine and femoral neck. Efficacy regarding fracture prevention cannot be concluded from this analysis, although bone density changes are correlated with fracture risk.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Bisphosphonates for treating osteoporosis caused by the use of steroids

Corticosteroids are widely used to treat inflammation. Bone loss (osteoporosis) is a serious side effect of this therapy. We reviewed a total of 13 trials which included 842 patients. We found that the bone mineral density of the lumbar spine of patients taking bisphosphonate therapy improved 4.3% more than patients who had no treatment. At the femoral neck (top of the thigh bone), the bone mineral density improved 2.1% more in the treatment group. There was no difference in the number of spinal fractures between the the two groups. We found that bisphosphonates are effective at preventing and treating corticosteroid-induced bone loss at the lumbar spine and femoral neck. We do not have enough evidence to say whether or not bisphosphonates prevent fractures.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

雙磷酸鹽類治療類固醇引起的骨質疏鬆症

類固醇廣泛用於治療發炎疾病包括結締組織疾病、氣喘、發炎性腸炎及器官移植。類固醇治療造成骨質流失是嚴重副作用之一。許多研究報告顯示雙磷酸鹽類治療類固醇引起的骨質疏鬆症效果不一。因此建議使用雙磷酸鹽類預防類固醇引起的骨質流失程度前須先評估。

目標

研究雙磷酸鹽類預防及治療類固醇引起骨質疏鬆症的效果。

搜尋策略

搜尋包括 Cochrane Musculoskeletal Group trials register, MEDLINE到1997 and EMBASE 1988 – 1997),CCTR,同時手動搜尋回顧文章之參考文獻及近5年研討會論文,及近6個月Current Contents。

選擇標準

所有研究雙磷酸鹽類預防及治療類固醇引起骨質疏鬆症的控制對照臨床研究。病人必需為每日服用7.5毫克或以上類固醇之成人。

資料收集與分析

兩位獨立作者進行資料摘錄及進行品質評估。結果為6到12個月在腰椎及股骨頸之骨密度改變。如有資料,新骨折的數目及因副作用退出也紀錄。連續及類別資料使用固定效果模型統合分析,當有異質性時,使用隨機效果模型統合分析。

主要結論

13個研究包含842例病患於分析中。結果為治療組與安慰劑組骨密度改變百分比之加權平均差異(WMD),並以變異數倒數為加權。在腰椎,骨密度改變百分比之加權平均差異為4.3% (95% CI 2.7, 5.9)。在股骨頸之加權平均差異為2.1% (95% CI 0.01, 3.8)。雖然脊椎骨折勝算減少24% ,但無統計差異 OR 0.76 (95% CI 0.37, 1.53)]。

作者結論

雙磷酸鹽類預防及治療類固醇引起骨質流失在股骨頸及腰椎有效果。雖然骨密度改變與骨折風險有關,無法由本研究下結論雙磷酸鹽類預防骨折是否有效。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

無總結