骨质疏松症的最好治疗方法尚不确定

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Best treatment for osteoporosis still unclear
Last Updated: 2007-12-26 13:00:05 -0400 (Reuters Health)

NEW YORK (Reuters Health) - A meta-analysis of studies of the various agents available to reduce risk of osteoporotic fractures shows that while many are effective, no single agent has a clear superiority in fracture prevention.

A search of the MEDLINE database of studies conducted between 1966 and 2007 of various therapies for osteoporosis and reduction of fracture risk and an analysis of treatment-related adverse events was conducted by Dr. Catherine MacLean and colleagues at the RAND Corporation in Los Angeles, California.

The results appear in an early online release of the Annals of Internal Medicine, to be published in the February 5 print issue.

The investigators screened 1,825 studies comparing a single agent with another agent or with placebo in reducing osteoporosis and fracture risk.

Dr. MacLean's team evaluated 14 agents, 9 involving bisphosphonates and one a head-to-head comparison of selective estrogen receptor-modulators (SERMS). The researchers evaluated changes in bone mineral density and changes in bone turnover markers.

Only two studies were head-to-head trials designed to compare fracture outcomes. One found no difference between alendronate and risedronate in prevention of vertebral fractures. The other was a comparison of raloxifene and alendronate and it was too small to be powered to evaluate differences in fracture risk reduction.

Dr. MacLean and colleagues found \"good evidence that alendronate, etidronate, ibandronate, risedronate, zoledronic acid, estrogen, parathyroid hormone and raloxifene prevent vertebral fractures more than placebo; the evidence for calcitonin was fair.\"

Alendronate, risedronate and estrogen appear to be superior to placebo in prevention of hip fractures. The effects of vitamin D on fracture risk varied by dose and analogue.

Risk of thrombolic events appeared to be increased with raloxifene, estrogen and estrogen-progestin. Esophageal and gastrointestinal ulcerations, bleeding and perforations appeared be a risk with etidronate.

The investigators conclude that \"although good evidence suggests that many agents are effective in preventing osteoporotic fractures, data are insufficient to determine the relative efficacy or safety of these agents.\"

Ann Intern Med 2008.

骨质疏松症的最好治疗方法尚不确定
纽约（路透社健康）2007年12月26日报道：一项各种药物减少骨质疏松性骨折风险的荟萃研究表明，虽然许多药物是有效的，但没有单一的药物在预防骨折方面有明显的优势。

美国的Catherine MacLean 博士和同事研究了MEDLINE数据库中1966年至2007年间相关的研究，其中包括治疗骨质疏松症、降低骨折风险的各种治疗方法，以及治疗相关副作用。

研究人员筛选了1825项研究，这些研究都比较了某种单一药物与另一药物或安慰剂在减少骨质疏松症和骨折风险中的效果。

MacLean博士的研究小组评估了14个药物，9个为双膦酸盐，以及选择性雌激素受体调节剂（SERMs）。研究人员评估了患者的骨密度和骨转化物的变化。