期刊
RHEUMATOLOGY
卷 60, 期 2, 页码 649-657出版社
OXFORD UNIV PRESS
DOI: 10.1093/rheumatology/keaa228
关键词
glucocorticoid-induced osteoporosis; bone loss; fractures; antiosteoporotic interventions; network meta-analysis
类别
This study conducted a network meta-analysis on the efficacy of antiosteoporotic interventions in adult patients taking glucocorticoids, finding that bisphosphonates, teriparatide, and denosumab are associated with decreased odds of fracture in these patients.
Objective To perform a network meta-analysis (NMA) on the efficacy of antiosteoporotic interventions in the prevention of vertebral and non-vertebral fractures in adult patients taking glucocorticoids (GCs). Methods We performed NMAs based on a prospectively developed protocol. A librarian-assisted database search of MEDLINE, EMBASE, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Cochrane Central Register of Controlled Trials (CENTRAL) and Chinese databases was conducted for randomized controlled trials (RCTs) comparing antiosteoporotic interventions in adult patients taking GCs. Outcomes were vertebral and non-vertebral fracture incidences. Results We included 56 RCTs containing 6479 eligible patients in our analysis. We found that alendronate and teriparatide were associated with decreased odds of both vertebral and non-vertebral fractures. Denosumab and risedronate were associated with decreased odds of vertebral fractures, while etidronate, ibandronate and alfacalcidol were associated with decreased odds of non-vertebral fractures. We observed low network heterogeneity as indicated by the I-2 statistic, and we did not detect evidence of publication bias. All outcomes were based on a moderate quality of evidence according to GRADE. Conclusion Bisphosphonates, teriparatide and denosumab are associated with decreased odds of fracture in patients undergoing GC therapy. Vitamin D metabolites and analogues (e.g. alfacalcidol) may have greater anti-fracture efficacy compared with plain vitamin D. Systematic Review Registration The International Prospective Register of Systematic Reviews (PROSPERO)-CRD42019127073
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