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【medical-news】骨质疏松症的最好治疗方法尚不确
Best treatment for osteoporosis still unclear
Last Updated: 2007-12-26 13:00:05 -0400 (Reuters Health)
NEW YORK (Reuters Health) - A meta-analysis of studies of the various agents available to reduce risk of osteoporotic fractures shows that while many are effective, no single agent has a clear superiority in fracture prevention.
A search of the MEDLINE database of studies conducted between 1966 and 2007 of various therapies for osteoporosis and reduction of fracture risk and an analysis of treatment-related adverse events was conducted by Dr. Catherine MacLean and colleagues at the RAND Corporation in Los Angeles, California.
The results appear in an early online release of the Annals of Internal Medicine, to be published in the February 5 print issue.
The investigators screened 1,825 studies comparing a single agent with another agent or with placebo in reducing osteoporosis and fracture risk.
Dr. MacLean's team evaluated 14 agents, 9 involving bisphosphonates and one a head-to-head comparison of selective estrogen receptor-modulators (SERMS). The researchers evaluated changes in bone mineral density and changes in bone turnover markers.
Only two studies were head-to-head trials designed to compare fracture outcomes. One found no difference between alendronate and risedronate in prevention of vertebral fractures. The other was a comparison of raloxifene and alendronate and it was too small to be powered to evaluate differences in fracture risk reduction.
Dr. MacLean and colleagues found "good evidence that alendronate, etidronate, ibandronate, risedronate, zoledronic acid, estrogen, parathyroid hormone and raloxifene prevent vertebral fractures more than placebo; the evidence for calcitonin was fair."
Alendronate, risedronate and estrogen appear to be superior to placebo in prevention of hip fractures. The effects of vitamin D on fracture risk varied by dose and analogue.
Risk of thrombolic events appeared to be increased with raloxifene, estrogen and estrogen-progestin. Esophageal and gastrointestinal ulcerations, bleeding and perforations appeared be a risk with etidronate.
The investigators conclude that "although good evidence suggests that many agents are effective in preventing osteoporotic fractures, data are insufficient to determine the relative efficacy or safety of these agents."
Ann Intern Med 2008.
骨质疏松症的最好治疗方法尚不确定
纽约（路透社健康）2007年12月26日报道：一项各种药物减少骨质疏松性骨折风险的荟萃研究表明，虽然许多药物是有效的，但没有单一的药物在预防骨折方面有明显的优势。
美国的Catherine MacLean 博士和同事研究了MEDLINE数据库中1966年至2007年间相关的研究，其中包括治疗骨质疏松症、降低骨折风险的各种治疗方法，以及治疗相关副作用。
研究人员筛选了1825项研究，这些研究都比较了某种单一药物与另一药物或安慰剂在减少骨质疏松症和骨折风险中的效果。
MacLean博士的研究小组评估了14个药物，9个为双膦酸盐，以及选择性雌激素受体调节剂（SERMs）。研究人员评估了患者的骨密度和骨转化物的变化。
所有研究中只有2项研究为一对一比较骨折结果的研究。其中一项研究表明，阿伦膦酸盐和利塞膦酸盐在预防椎体骨折中没有显著差异；另一项是比较雷洛昔芬和阿仑膦酸盐的，但由于这项研究规模太小，无法评估骨折风险减少的差异。
MacLean博士和同事们发现，"有充分的证据显示，阿仑膦酸盐，依替膦酸盐，伊班膦酸盐，利塞膦酸盐，唑来膦酸盐，雌激素，甲状旁腺激素和雷洛昔芬与安慰剂相比，能有效的预防椎体骨折;降钙素的证据为中等。”
阿仑膦酸盐，利塞膦酸盐和雌激素在预防髋骨骨折方面要优于安慰剂。维生素D对骨折风险的影响，不同剂量及类似物。
使用雷洛昔芬，雌激素与雌激素孕激素患者的血栓风险增加，使用依替膦酸盐患者的食管和胃肠道溃疡，出血和穿孔的风险增加。
研究人员总结说：“虽然有很好的证据表明，许多药物都可以有效预防骨质疏松性骨折，但是仍不足以确定这些药物的相对疗效及安全性”。
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作者:admin@医学,生命科学 2011-06-07 05:14
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