Can Bisphosphonate Therapy Reduce Overall Mortality in Patients With Osteoporosis? A Meta-analysis of Randomized Controlled Trials

医学 荟萃分析 随机对照试验 安慰剂 梅德林 科克伦图书馆 子群分析 双膦酸盐 骨质疏松症 内科学 系统回顾 临床试验 物理疗法 替代医学 病理 政治学 法学
作者
Zhibin Lan,Xue Lin,Di Xue,Yang Yang,Muhammad Saad,Qunhua Jin
出处
期刊:Clinical Orthopaedics and Related Research [Ovid Technologies (Wolters Kluwer)]
标识
DOI:10.1097/corr.0000000000003204
摘要

Background For patients with osteoporosis, bisphosphonate therapy can reduce the risk of fractures, but its effect on reducing mortality remains unclear. Previous studies on this topic have produced conflicting results and generally have been too small to definitively answer the question of whether bisphosphonate therapy reduces mortality. Therefore, a meta-analysis may help us arrive at a more conclusive answer. Questions/purposes In a large meta-analysis of placebo-controlled randomized controlled trials (RCTs), we asked: (1) Does bisphosphonate use reduce mortality? (2) Is there a subgroup effect based on whether different bisphosphonate drugs were used (zoledronate, alendronate, risedronate, and ibandronate), different geographic regions where the study took place (Europe, the Americas, and Asia), whether the study was limited to postmenopausal female patients, or whether the trials lasted 3 years or longer? Methods We conducted a systematic review using multiple databases, including Embase, Web of Science, Medline (via PubMed), Cochrane Library, and ClinicalTrials.gov, with each database searched up to November 20, 2023 (which also was the date of our last search), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included randomized, placebo-controlled clinical trials with participants diagnosed with osteoporosis and receiving bisphosphonate treatment. We excluded papers posted to preprint servers, other unpublished work, conference abstracts, and papers that were registered on ClinicalTrials.gov but were not yet published. We collected 2263 records. After excluding records due to study type, study content not meeting the inclusion criteria, and duplicates, our meta-analysis included 47 placebo-controlled RCTs involving 59,437 participants. Data extraction, quality assessment, and statistical analyses were performed. The evaluation of randomized trials for potential bias was conducted using the revised Cochrane Risk of Bias tool. This assessment encompassed factors such as sequence generation, allocation concealment, subject blinding, outcome assessor blinding, incomplete outcome data, and reporting bias. Some studies did not provide explicit details regarding random sequence generation, leading to a high risk of selection bias. A few studies, due to their open-label nature, were unable to achieve double-blind conditions for both the subjects and the researchers, resulting in intermediate performance bias. Nevertheless, the overall study quality was high. Due to the low heterogeneity among the studies, as evidenced by the low statistical heterogeneity (that is, a low I 2 statistic), we opted for a fixed-effects model, indicating that the effect size is consistent across the studies. In such cases, the fixed-effects model can provide more precise estimates. According to the results of the funnel plot, we did not find evidence of publication bias. Results The use of bisphosphonates did not reduce the overall risk of mortality in patients with osteoporosis (risk ratio 0.95 [95% CI 0.88 to 1.03]). Subgroup analyses involving different bisphosphonate drugs (zoledronate, alendronate, risedronate, and ibandronate), regions (Europe, the Americas, and Asia), diverse populations (postmenopausal female patients and other patients), and trials lasting 3 years or longer revealed no associations with reduced overall mortality. Conclusion Based on our comprehensive meta-analysis, there is high-quality evidence suggesting that bisphosphonate therapy for patients with osteoporosis does not reduce the overall risk of mortality despite its effectiveness in reducing the risk of fractures. The primary consideration for prescribing bisphosphonates to individuals with osteoporosis should continue to be centered on reducing fracture risk, aligning with clinical guidelines. Long-term studies are needed to investigate potential effects on mortality during extended treatment periods. Level of Evidence Level I, therapeutic study.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
大幅提高文件上传限制,最高150M (2024-4-1)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
在水一方应助佳丽采纳,获得10
刚刚
1秒前
健忘的冰薇完成签到,获得积分10
1秒前
曦曦呵呵发布了新的文献求助10
1秒前
犹豫的梦山完成签到,获得积分10
1秒前
quhayley应助威威酱油公司采纳,获得10
1秒前
unyoah完成签到,获得积分10
2秒前
jiangxiaoyu完成签到,获得积分10
2秒前
杂货店的铺老板完成签到 ,获得积分10
2秒前
3秒前
威武依琴发布了新的文献求助10
3秒前
科研通AI2S应助林林采纳,获得10
4秒前
领导范儿应助才哥采纳,获得10
4秒前
丘比特应助jxp采纳,获得10
4秒前
ddm发布了新的文献求助10
4秒前
4秒前
小李完成签到,获得积分20
5秒前
科研狗完成签到,获得积分10
5秒前
853225598发布了新的文献求助10
6秒前
义气千雁完成签到 ,获得积分10
6秒前
6秒前
7秒前
火山排骨完成签到,获得积分10
7秒前
落寞的盼夏完成签到,获得积分10
7秒前
七七发布了新的文献求助10
7秒前
8秒前
9秒前
南生完成签到,获得积分10
9秒前
guagua发布了新的文献求助10
11秒前
11秒前
从容猫咪发布了新的文献求助10
12秒前
坚强的皮皮虾完成签到,获得积分10
12秒前
12秒前
洪焕良发布了新的文献求助10
12秒前
13秒前
我刚上小学完成签到,获得积分10
13秒前
ppboyindream发布了新的文献求助10
13秒前
single发布了新的文献求助10
13秒前
善学以致用应助YK采纳,获得10
13秒前
14秒前
高分求助中
Evolution 10000
Sustainability in Tides Chemistry 2800
The Young builders of New china : the visit of the delegation of the WFDY to the Chinese People's Republic 1000
юрские динозавры восточного забайкалья 800
A new approach of magnetic circular dichroism to the electronic state analysis of intact photosynthetic pigments 500
Diagnostic immunohistochemistry : theranostic and genomic applications 6th Edition 500
Chen Hansheng: China’s Last Romantic Revolutionary 500
热门求助领域 (近24小时)
化学 医学 生物 材料科学 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 基因 遗传学 催化作用 物理化学 免疫学 量子力学 细胞生物学
热门帖子
关注 科研通微信公众号,转发送积分 3148940
求助须知:如何正确求助?哪些是违规求助? 2800005
关于积分的说明 7837927
捐赠科研通 2457512
什么是DOI,文献DOI怎么找? 1307891
科研通“疑难数据库(出版商)”最低求助积分说明 628322
版权声明 601685