双酸盐治疗可以降低骨质疏松症患者的整体死亡率吗? 随机对照试验的元分析
Zhibin Lan1, Xue Lin1,2, Di Xue1,2
1The Third Ward of Orthopaedic Department, General Hospital of Ningxia Medical University, Yinchuan, PR China.
Clinical orthopaedics and related research
|August 22, 2024
概括
根据一项大型元分析,治疗骨质疏松症的双酸盐并不能降低整体死亡风险. 虽然有效预防骨折,但其对生存的影响在各种双酸盐药物和患者群体中仍未得到证实.
科学领域:
- 药理学和治疗学 药理学和治疗学
- 骨代谢和骨质疏松症研究研究
- 临床流行病学和生物统计学
背景情况:
- 双酸盐疗法已确立用于减少骨质疏松症中骨折风险.
- 双酸盐对骨质疏松症患者整体死亡率的影响尚不确定.
- 之前的研究产生了相互矛盾的结果,缺乏足够的统计能力.
研究的目的:
- 通过元分析来确定双酸盐的使用是否会降低骨质疏松症患者的死亡率.
- 根据双酸盐类型,地区,人口和试验持续时间,调查潜在的子组对死亡率的影响.
主要方法:
- 47个安慰剂对照随机对照试验 (RCT) 的系统审查和元分析,涉及59,437名参与者.
- 搜索了多个数据库 (Embase,科学网,Medline,Cochrane,临床试验.gov) 截至2023年11月20日.
- 利用PRISMA指南和修订后的Cochrane偏差风险工具;由于异质性较低,采用固定效应模型.
主要成果:
- 双酸盐的使用并没有显著降低整体死亡风险 (RR 0.95;95% CI 0.88-1.03).
- 跨不同双酸盐药物,地理区域,人群 (包括绝经后女性) 和试验持续时间 (≥3年) 的亚组分析显示,死亡率没有降低.
- 通过漏斗图形分析,没有发现出版偏差的证据.
结论:
- 高质量的证据表明,对骨质疏松症的双酸盐治疗不会降低整体死亡率.
- 在骨质疏松症中使用双酸盐的主要适应症仍然是骨折风险降低.
- 需要进一步的长期研究来探索延长治疗对死亡率的潜在影响.
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