激素替代疗法和预防非脊椎骨折:随机试验的元分析
1University of York, Genesis 6, University Road, Heslington, YO10 5DQ England. djt6@york.ac.uk
JAMA
|June 13, 2001
概括
激素替代疗法 (HRT) 显著减少了绝经后妇女的非脊椎骨折. 在60岁以下的年轻女性中,HRT对骨折减少的益处更为明显.
科学领域:
- 骨健康和骨质疏松症研究
- 临床试验和元分析
- 激素治疗的有效性 激素治疗的有效性
背景情况:
- 观察性研究表明,激素替代疗法 (HRT) 可以降低骨折风险,但随机对照试验 (RCT) 的强有力的证据有限.
- 之前的研究并没有根据高质量的试验数据确定HRT对骨折预防的有效性.
研究的目的:
- 系统地审查所有收集非脊椎骨折数据的HRT的RCT,无论主要研究重点是什么.
- 整合和分析符合条件的HRT试验中的骨折数据,以评估治疗效果.
主要方法:
- 进行全面的数据库搜索 (MEDLINE,EMBASE等) 并与研究人员/公司联系,以确定2000年之前发表的相关RCT.
- 纳入标准要求至少持续12个月的试验与可用的非脊椎骨折数据;分析了22项试验.
- 使用Jadad规模进行独立的数据提取和质量评估,以确保方法严格.
主要成果:
- 对22项RCT的综合分析显示,HRT对非脊椎骨折的统计显著减少27% (RR,0.73;95% CI,0.56-0.94).
- 骨折减少效应在60岁以下的女性中 (RR,0.67) 与60岁及以上的女性相比 (RR,0.88) 更为显著.
- HRT对部和手腕骨折显著有效,特别是在年轻女性 (RR,0.45) 中.
结论:
- 对RCT的元分析证实了HRT相关的非脊椎骨折的统计显著减少.
- 在老年妇女 (≥60岁) 中,HRT对骨折减少的有益作用可能不那么明显.
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