摘要
背景:比较骨折发生率可以做为衡量抗骨质疏松药物疗效的一种手段,目前比较不同种类的抗骨质疏松药物网络Meta分析较少。目的:应用网络Meta全面评价不同抗骨质疏松药物减少绝经妇女椎体骨折和非椎体骨折风险。方法:回顾了The Cochrane Library,Pub Med,EMbase,万方,中国生物医学文献数据库(CBM),维普网(VIP)及中国知网(CNKI)查找关于绝经妇女用抗骨质疏松药物的椎体骨折和非椎体骨折随机对照试验。检索时限均为从建库至2014年7月。由2名研究者独立根据纳入与排除标准独立筛选文献、提取资料并评价纳入研究的方法学质量,采用Win BUGS 1.4.3和R 3.03软件用随机效应模型和固定效应模型进行网络Meta分析。结果与结论:46个RCTs评价椎体骨折风险和42个RCTs评价非椎体骨折风险,双膦酸盐(阿仑膦酸盐、利塞膦酸盐、伊班膦酸盐、依替膦酸盐、唑来膦酸盐)、甲状腺激素(特立帕特)、生物制剂(狄诺塞麦),或者选择性雌激素受体调节剂(雷洛昔芬、巴多昔芬)包括在系统评价内。单个研究结果间接比较绝经妇女不同治疗效果网络Meta分析。运用Win BUGS 1.4.3贝叶斯随机效应模型进行Meta分析结果的OR和95%CI。唑来膦酸盐在椎体骨折的预防最佳,利塞膦酸盐较其他药物更好的减少非椎体骨折。目前网络Meta分析不能给予确定的结论,需要更大规模的的前瞻性研究来证实研究结果。
BACKGROUND：Comparison of the incidence of fracture can be used as a manner to evaluate the therapeutic effects of anti-osteoporosis drugs. At present, there are a few network meta-analysis on different kinds of anti-osteoporosis drugs. OBJECTIVE：To comprehensively evaluate the risks of different anti-osteoporosis drugs in reducing the vertebral and non-vertebral fractures in postmenopausal women by applying Network Meta-analysis. METHODS： We retrieved The Cochrane Library, PubMed, EMbase, Wanfang, China Biology Medicine, VIP and China National Knowledge Infrastructure for randomized controled trials about vertebral and non-vertebral fractures in postmenopausal women taking anti-osteoporosis drugs. Retrieval time was from building a database to July 2014. Two reviewers extracted and assessed independently the outcomes and quality of included trials according to inclusion and exclusion criteria. We used random effects Bayesian models and fixed effects Bayesian model in WinBUGS 1.4.3 combined R 3.03 software in the network meta-analysis. RESULTS AND CONCLUSION：Forty-six randomized controled trials on vertebral fracture and forty-two randomized controled trials on non-vertebral risk reduction with bisphosphonates （alendronate, risedronate, ibandronate, etidronate, and zoledronic acid）, parathyroid hormone （teriparatide）, biologics （denosumab）, or selective estrogen receptor modulators （raloxifene, bazedoxifene） were identified by a systematic review.＆nbsp;Individual study results were pooled in a network meta-analysis to indirectly compare treatment effects in postmenopausal women. The odd ratio and 95% confidence interval of drugs were estimated using random effects Bayesian models in WinBUGS 1.4.3. Zoledronic acid was best in the prevention of vertebral fractures. Risedronate reduced the risk of non-vertebral fracture in postmenopausal women better than other drugs. However, current network meta-analysis cannot give a certain conclusion. A large perspective study designed specialy for c
出处
《中国组织工程研究》
CAS
北大核心
2015年第4期648-656,共9页
Chinese Journal of Tissue Engineering Research
