ホルモン置換療法と非脊椎骨折の予防:ランダム化試験のメタ分析
1University of York, Genesis 6, University Road, Heslington, YO10 5DQ England. djt6@york.ac.uk
JAMA
|June 13, 2001
まとめ
ホルモン置換療法 (HRT) は,閉経後の女性における非脊椎骨折を著しく減少させます. HRTの骨折減少の利点は,60歳未満の若い女性ではより顕著です.
科学分野:
- 骨の健康と骨粗鬆症の研究
- 臨床試験とメタ分析について
- ホルモン療法の有効性について
背景:
- 観察研究は,ホルモン置換療法 (HRT) が骨折のリスクを軽減することを示唆しているが,ランダム化対照試験 (RCT) からの確固たる証拠は限られている.
- 以前の研究は,高品質の試験データに基づいて,骨折の予防のためのHRTの有効性を決定的に確立していない.
研究 の 目的:
- 主要な研究の焦点に関係なく,非脊椎骨折データを収集したHRTのすべてのRCTを体系的にレビューする.
- 治療効果を評価するために,適格なHRT試験からの骨折データを統合および分析する.
主な方法:
- 総合的なデータベース検索 (MEDLINE,EMBASEなど) 研究者/企業と連絡を取り,2000年まで発表された関連するRCTを特定します.
- 含有基準は,利用可能な非脊椎骨折データで少なくとも12ヶ月間の試験を必要とし,22件の試験が分析されました.
- 方法論的厳格性を確保するために,Jadadスケールを用いて独立したデータ抽出と品質評価を行います.
主要な成果:
- 22件のRCTのプール分析により,HRTによる非脊椎骨折の統計的に有意な27%の減少が明らかになった (RR,0.73;95%CI,0.56-0.94).
- 骨折の減少効果は,60歳以上の女性 (RR,0.88) に比べて60歳未満の女性 (RR,0.67) でより顕著でした.
- HRTは,特に若い女性 (RR,0.45) で,ヒップと手首の骨折に対して顕著な効果を示しました.
結論:
- RCTのメタ解析は,HRTに関連した非脊椎骨折の統計的に有意な減少を確認しています.
- HRTが骨折の軽減に与える有益な効果は,高齢女性 (60歳以上) ではあまり顕著ではないかもしれません.
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