Pharmacologic intervention for prevention of fractures in osteopenic and osteoporotic postmenopausal women: Systemic review and meta-analysis
Objectives: Emerging evidence has indicated a role for pharmacologic agents in the primary prevention of osteoporotic fracture, but have not yet been systematically reviewed for meta-analysis. We conducted a meta-analysis to evaluate the efficacy of pharmacologic interventions in reducing fracture r...
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Elsevier
2020-12-01
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Series: | Bone Reports |
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Online Access: | http://www.sciencedirect.com/science/article/pii/S2352187220304897 |
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Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Chih-Hsing Wu Wei-Chieh Hung Ing-Lin Chang Tsung-Ting Tsai Yin-Fan Chang Eugene V. McCloskey Nelson B. Watts Michael R. McClung Chun-Feng Huang Chung-Hwan Chen Kun-Ling Wu Keh-Sung Tsai Ding-Cheng Chan Jung-Fu Chen Shih-Te Tu Jawl-Shan Hwang Weibo Xia Toshio Matsumoto Yoon-Sok Chung Cyrus Cooper John A. Kanis Rong-Sen Yang Wing P. Chan |
spellingShingle |
Chih-Hsing Wu Wei-Chieh Hung Ing-Lin Chang Tsung-Ting Tsai Yin-Fan Chang Eugene V. McCloskey Nelson B. Watts Michael R. McClung Chun-Feng Huang Chung-Hwan Chen Kun-Ling Wu Keh-Sung Tsai Ding-Cheng Chan Jung-Fu Chen Shih-Te Tu Jawl-Shan Hwang Weibo Xia Toshio Matsumoto Yoon-Sok Chung Cyrus Cooper John A. Kanis Rong-Sen Yang Wing P. Chan Pharmacologic intervention for prevention of fractures in osteopenic and osteoporotic postmenopausal women: Systemic review and meta-analysis Bone Reports Fracture Low bone mass Osteopenia Osteoporosis Primary prevention |
author_facet |
Chih-Hsing Wu Wei-Chieh Hung Ing-Lin Chang Tsung-Ting Tsai Yin-Fan Chang Eugene V. McCloskey Nelson B. Watts Michael R. McClung Chun-Feng Huang Chung-Hwan Chen Kun-Ling Wu Keh-Sung Tsai Ding-Cheng Chan Jung-Fu Chen Shih-Te Tu Jawl-Shan Hwang Weibo Xia Toshio Matsumoto Yoon-Sok Chung Cyrus Cooper John A. Kanis Rong-Sen Yang Wing P. Chan |
author_sort |
Chih-Hsing Wu |
title |
Pharmacologic intervention for prevention of fractures in osteopenic and osteoporotic postmenopausal women: Systemic review and meta-analysis |
title_short |
Pharmacologic intervention for prevention of fractures in osteopenic and osteoporotic postmenopausal women: Systemic review and meta-analysis |
title_full |
Pharmacologic intervention for prevention of fractures in osteopenic and osteoporotic postmenopausal women: Systemic review and meta-analysis |
title_fullStr |
Pharmacologic intervention for prevention of fractures in osteopenic and osteoporotic postmenopausal women: Systemic review and meta-analysis |
title_full_unstemmed |
Pharmacologic intervention for prevention of fractures in osteopenic and osteoporotic postmenopausal women: Systemic review and meta-analysis |
title_sort |
pharmacologic intervention for prevention of fractures in osteopenic and osteoporotic postmenopausal women: systemic review and meta-analysis |
publisher |
Elsevier |
series |
Bone Reports |
issn |
2352-1872 |
publishDate |
2020-12-01 |
description |
Objectives: Emerging evidence has indicated a role for pharmacologic agents in the primary prevention of osteoporotic fracture, but have not yet been systematically reviewed for meta-analysis. We conducted a meta-analysis to evaluate the efficacy of pharmacologic interventions in reducing fracture risk and increasing bone mineral density (BMD) in postmenopausal women with osteopenia or osteoporosis but without prevalent fragility fracture. Method: The Medline, EMBASE, and CENTRAL databases were searched from inception to September 30, 2019. Only randomized placebo-controlled trials evaluating postmenopausal women with −1.0 > bone mineral density (BMD) T-score > −2.5 (low bone mass) and those with BMD T-score ≤ −2.5 (osteoporosis) but without baseline fractures, who were receiving anti-osteoporotic agents, providing quantitative outcomes data and evaluating risk of vertebral and/or non-vertebral fragility fracture at follow-up. The PRISMA guidelines were followed, applying a random-effects model. The primary endpoint was the effect of anti-osteoporotic regimens in reducing the incidence of vertebral fractures. Secondary endpoints were percentage changes in baseline BMD at the lumbar spine and total hip at 1 and 2 years follow up. Results: Full-text review of 144 articles yielded, 20 for meta-analysis. Bisphosphonates reduced the risk of vertebral fracture (pooled OR = 0.50, 95%CIs = 0.36–0.71) and significantly increased lumbar spine BMD after 1 year, by 4.42% vs placebo (95%CIs = 3.70%–5.14%). At the hip, this value was 2.94% (95%CIs = 2.13%–3.75%). Overall results of limited studies for non-bisphosphonate drugs showed increased BMD and raloxifene significantly decreases the risk of subsequent clinical vertebral fractures. Conclusion: The bisphosphonates are efficacious and most evident for the primary prevention of osteoporotic vertebral fractures, reducing their incidence and improving BMD in postmenopausal women with osteopenia or osteoporosis. |
topic |
Fracture Low bone mass Osteopenia Osteoporosis Primary prevention |
url |
http://www.sciencedirect.com/science/article/pii/S2352187220304897 |
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doaj-81a5d8098a084b9db4e9456be94af7662020-12-23T05:00:22ZengElsevierBone Reports2352-18722020-12-0113100729Pharmacologic intervention for prevention of fractures in osteopenic and osteoporotic postmenopausal women: Systemic review and meta-analysisChih-Hsing Wu0Wei-Chieh Hung1Ing-Lin Chang2Tsung-Ting Tsai3Yin-Fan Chang4Eugene V. McCloskey5Nelson B. Watts6Michael R. McClung7Chun-Feng Huang8Chung-Hwan Chen9Kun-Ling Wu10Keh-Sung Tsai11Ding-Cheng Chan12Jung-Fu Chen13Shih-Te Tu14Jawl-Shan Hwang15Weibo Xia16Toshio Matsumoto17Yoon-Sok Chung18Cyrus Cooper19John A. Kanis20Rong-Sen Yang21Wing P. Chan22Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Geriatrics, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Correspondence to: C-H. Wu, Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.Department of Family Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan; Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung, Taiwan; Medicine for International Student, I-Shou University, Kaohsiung, TaiwanDepartment of Orthopaedics, ChangHua Christian Hospital, ChangHua, TaiwanDepartment of Orthopedics, Chang Gung Memorial Hospital, Chang Gung University, Linkou, TaiwanDepartment of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, TaiwanAcademic Unit of Bone Metabolism, University of Sheffield, Sheffield, UKMercy Health Osteoporosis and Bone Health Services, Cincinnati, OH, USAThe Oregon Osteoporosis Center, Portland, OR, USADepartment of Family Medicine, National Yang Ming University Hospital, I-Lan, TaiwanOrthopaedic Research Centre, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Orthopaedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung City, Taiwan; Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, TaiwanDepartment of Family Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan City, Taiwan; Outpatient Clinic Department, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan City, TaiwanDepartment of Internal Medicine, National Taiwan University Hospital, Taipei, TaiwanSuperintendent Office, National Taiwan University Hospital Chu-Tung Branch, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, TaiwanDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, TaiwanDivision of Endocrinology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, TaiwanDivision of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Linkou, TaiwanDepartment of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, ChinaFujii Memorial Institute of Medical Sciences, University of Tokushima, JapanDepartment of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South KoreaMRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Oxford National Institute for Health Research Biomedical Research Centre, University of Oxford, Oxford, UKMary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia; Centre for Metabolic Bone Diseases, University of Sheffield Medical School, UKDepartment of Orthopaedics, College of Medicine, National Taiwan University & Hospital, Taipei, TaiwanDepartment of Radiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Correspondence to: W P. Chan, Department of Radiology, Wan Fang Hospital, Taipei Medical University, 111 Hsing-Long Road, Section 3, Taipei 116, Taiwan.Objectives: Emerging evidence has indicated a role for pharmacologic agents in the primary prevention of osteoporotic fracture, but have not yet been systematically reviewed for meta-analysis. We conducted a meta-analysis to evaluate the efficacy of pharmacologic interventions in reducing fracture risk and increasing bone mineral density (BMD) in postmenopausal women with osteopenia or osteoporosis but without prevalent fragility fracture. Method: The Medline, EMBASE, and CENTRAL databases were searched from inception to September 30, 2019. Only randomized placebo-controlled trials evaluating postmenopausal women with −1.0 > bone mineral density (BMD) T-score > −2.5 (low bone mass) and those with BMD T-score ≤ −2.5 (osteoporosis) but without baseline fractures, who were receiving anti-osteoporotic agents, providing quantitative outcomes data and evaluating risk of vertebral and/or non-vertebral fragility fracture at follow-up. The PRISMA guidelines were followed, applying a random-effects model. The primary endpoint was the effect of anti-osteoporotic regimens in reducing the incidence of vertebral fractures. Secondary endpoints were percentage changes in baseline BMD at the lumbar spine and total hip at 1 and 2 years follow up. Results: Full-text review of 144 articles yielded, 20 for meta-analysis. Bisphosphonates reduced the risk of vertebral fracture (pooled OR = 0.50, 95%CIs = 0.36–0.71) and significantly increased lumbar spine BMD after 1 year, by 4.42% vs placebo (95%CIs = 3.70%–5.14%). At the hip, this value was 2.94% (95%CIs = 2.13%–3.75%). Overall results of limited studies for non-bisphosphonate drugs showed increased BMD and raloxifene significantly decreases the risk of subsequent clinical vertebral fractures. Conclusion: The bisphosphonates are efficacious and most evident for the primary prevention of osteoporotic vertebral fractures, reducing their incidence and improving BMD in postmenopausal women with osteopenia or osteoporosis.http://www.sciencedirect.com/science/article/pii/S2352187220304897FractureLow bone massOsteopeniaOsteoporosisPrimary prevention |