Prevention of vertebral and non-vertebral fractures in postmenopausal women with anti-osteoporosis drugs: a network meta-analysis

doi:10.3969/j.issn.2095-4344.2015.04.027

Abstract

Abstract:

BACKGROUND: Comparison of the incidence of fracture can be used as a manner to evaluate the therapeutic effects of anti-osteoporosis drugs. At present, there are a few network meta-analysis on different kinds of anti-osteoporosis drugs.

OBJECTIVE: To comprehensively evaluate the risks of different anti-osteoporosis drugs in reducing the vertebral and non-vertebral fractures in postmenopausal women by applying Network Meta-analysis.

METHODS: We retrieved The Cochrane Library, PubMed, EMbase, Wanfang, China Biology Medicine, VIP and China National Knowledge Infrastructure for randomized controlled trials about vertebral and non-vertebral fractures in postmenopausal women taking anti-osteoporosis drugs. Retrieval time was from building a database to July 2014. Two reviewers extracted and assessed independently the outcomes and quality of included trials according to inclusion and exclusion criteria. We used random effects Bayesian models and fixed effects Bayesian model in WinBUGS 1.4.3 combined R 3.03 software in the network meta-analysis.

RESULTS AND CONCLUSION: Forty-six randomized controlled trials on vertebral fracture and forty-two randomized controlled trials on non-vertebral risk reduction with bisphosphonates (alendronate, risedronate, ibandronate, etidronate, and zoledronic acid), parathyroid hormone (teriparatide), biologics (denosumab), or selective estrogen receptor modulators (raloxifene, bazedoxifene) were identified by a systematic review. Individual study results were pooled in a network meta-analysis to indirectly compare treatment effects in postmenopausal women. The odd ratio and 95% confidence interval of drugs were estimated using random effects Bayesian models in WinBUGS 1.4.3. Zoledronic acid was best in the prevention of vertebral fractures. Risedronate reduced the risk of non-vertebral fracture in postmenopausal women better than other drugs. However, current network meta-analysis cannot give a certain conclusion. A large perspective study designed specially for confirmation is needed to confirm the results of our study.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

全文链接：

Key words: Osteoporosis, Postmenopausal, Diphosphonates, Thyroxine

CLC Number:

R318

Wang Jun, Ma Ting-ting, Zhang Yi-na, Zhang Jin-ping, Guo Jing-xue. Prevention of vertebral and non-vertebral fractures in postmenopausal women with anti-osteoporosis drugs: a network meta-analysis [J]. Chinese Journal of Tissue Engineering Research, 2015, 19(4): 648-656.

Figures/Tables 5

非椎体椎体网络Meta分析结显示比较结果OR及其95%CI见表3。在椎体骨折风险的Meta分析中，各类药物与安慰剂相较，均明显降低椎体骨折风险。双膦酸盐药物中唑来膦酸盐的预防椎体骨折效果显著，唑来膦酸盐与其他药物进行比较，其次为狄诺塞麦、甲状旁腺激素、依替膦酸盐。伊班膦酸钠在比较中，其预防椎体骨折及非椎体骨折效果最弱。非椎体骨折网络Meta析结果中，利塞膦酸盐较其他药物非椎体骨折的发生率更小，除伊班膦酸盐之外，各类药物与安慰剂相较，均明显降低非椎体骨折风险。在非椎体骨折的预防中，与安慰剂相较，除伊班膦酸盐外均明显降低椎体骨折风险，利塞膦酸盐的效果最突出，其次为唑来膦酸盐、甲状腺激素、狄诺塞麦。雌激素受体调节剂中，雷洛昔芬和巴多昔芬进行比较，椎体骨折巴多昔芬比雷洛昔芬预防椎体和非椎体骨折效果更好。本文用了随机效应模型，对于多臂试验也采用了的拆分法。椎体的网络Mmeta干预措施之间关系图见图1，非椎体骨折网络Meta分析干预措施之间关系图见图2。图1和图2中的连接线表示相连接的两种干预措施之间有直接比较的证据，无连接线的两种干预措施可采用网状分析进行间接比较线的粗细表示纳入研究数目多少圆点大小表示该干预措施的合计样本量。 2.4.2 网络Meta模型收敛度检测利用WinBUGS 1.4.3软件在R 3.0.3软件上建立模型绘制图片检测模型收敛度，椎体网络Meta森林图显示Rhat=1，非椎体网络Meta森林图显示Rhat=1，椎体及非椎体的随机效应模型的收敛度均良好。 2.4.3 网络Meta一致性分析椎体网络meta一致性分析结果如图3及非椎体网络Meta一致性分析结果如图4显示数据中治疗措施形成三角关系，其可信区间与空白值相交，表明两项网络Meta分析计算所得结果与直接相比较所得的结果无明显差异，一致性较好。圆点大小代表研究数量，线长代表可信区间。椎体网络Meta分析和非椎体的网络Meta分析的一致性良好。 2.4.4 网络Meta敏感性分析本文分别采用随机效应模型及固定效应模型分别计算totresdev、pD、DIC。以上3个检测指标网络Meta分析数据是否稳健，随机效应模型的以上3个指标分别于固定效应模型结果相近认为数据稳定性较好。椎体及非椎体敏感性分析结果分别见表4。椎体骨折网络Meta分析中两个模型分别所得出的3个指标略有差异，可能有质量较差的文献影响数据的稳健。非椎体骨折的敏感性分析可见3个数据相近，其Meta分析结果数据较稳健。"

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