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Terapia de reemplazo hormonal y prevención de fracturas no vertebrales: un metanálisis de ensayos aleatorizados
1University of York, Genesis 6, University Road, Heslington, YO10 5DQ England. djt6@york.ac.uk
JAMA
|June 13, 2001
Resumen
La terapia de reemplazo hormonal (TRH) reduce significativamente las fracturas no vertebrales en mujeres posmenopáusicas. El beneficio de la reducción de fracturas de la TRH es más pronunciado en mujeres más jóvenes menores de 60 años.
Área de la Ciencia:
- La salud ósea y la investigación de la osteoporosis.
- Ensayos clínicos y metanálisis.
- Eficacia de la terapia hormonal en la eficacia de la terapia hormonal
Sus antecedentes:
- Los estudios de observación sugieren que la terapia de reemplazo hormonal (TRH) reduce el riesgo de fractura, pero la evidencia sólida de los ensayos controlados aleatorios (ECA) es limitada.
- Investigaciones anteriores no han establecido definitivamente la eficacia de la TRH para la prevención de fracturas basándose en datos de ensayos de alta calidad.
Objetivo del estudio:
- Revisar sistemáticamente todos los ECA de TRH que recogieron datos de fracturas no vertebrales, independientemente del enfoque primario del estudio.
- Para consolidar y analizar los datos de fractura de los ensayos de TRH elegibles para evaluar los efectos del tratamiento.
Principales métodos:
- Búsquedas exhaustivas en las bases de datos (MEDLINE, EMBASE, etc.) y el contacto con investigadores/empresas para identificar los ECA relevantes publicados hasta el año 2000.
- Los criterios de inclusión requerían ensayos de al menos 12 meses de duración con datos disponibles de fracturas no vertebrales; se analizaron 22 ensayos.
- Extracción independiente de datos y evaluación de la calidad utilizando la escala Jadad para garantizar el rigor metodológico.
Principales resultados:
- El análisis combinado de 22 ECA reveló una reducción estadísticamente significativa del 27% en las fracturas no vertebrales con TRH (RR, 0,73; IC del 95%, 0,56-0,94).
- El efecto de reducción de fracturas fue más sustancial en mujeres menores de 60 años (RR, 0.67) en comparación con las de 60 años o más (RR, 0.88).
- La TRH mostró una marcada eficacia para las fracturas de cadera y muñeca, particularmente en mujeres más jóvenes (RR, 0,45).
Conclusiones:
- El metanálisis de ECA confirma una reducción estadísticamente significativa en las fracturas no vertebrales asociadas con la TRH.
- El efecto beneficioso de la TRH en la reducción de fracturas puede ser menos pronunciado en mujeres mayores (≥60 años).
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