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Pharmacologic intervention for prevention of fractures in osteopenic and osteoporotic postmenopausal women: Systemic review and meta-analysis

Pharmacologic intervention for prevention of fractures in osteopenic and osteoporotic postmenopausal women: Systemic review and meta-analysis
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 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.
Wu, Chih-Hsing
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Hung, Wei-Chieh
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Chang, Ing-Lin
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Tsai, Tsung-Ting
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Chang, Yin-Fan
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Mccloskey, Eugene V.
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Watts, Nelson B.
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Mcclung, Michael R.
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Huang, Chun-Feng
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Chen, Chung-Hwan
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Wu, Kun-Ling
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Tsai, Keh-Sung
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Chan, Ding-Cheng
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Chen, Jung-Fu
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Tu, Shih-Te
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Hwang, Jawl-Shan
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Matsumoto, Toshio
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Chung, Yoon-Sok
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Cooper, Cyrus
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Kanis, John A.
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Yang, Rong-Sen
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Chan, Wing P.
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Wu, Chih-Hsing
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Hung, Wei-Chieh
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Chang, Ing-Lin
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Tsai, Tsung-Ting
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Chang, Yin-Fan
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Mccloskey, Eugene V.
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Watts, Nelson B.
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Mcclung, Michael R.
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Huang, Chun-Feng
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Chen, Chung-Hwan
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Wu, Kun-Ling
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Tsai, Keh-Sung
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Chan, Ding-Cheng
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Chen, Jung-Fu
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Tu, Shih-Te
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Hwang, Jawl-Shan
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Xia, Weibo
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Matsumoto, Toshio
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Chung, Yoon-Sok
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Cooper, Cyrus
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Kanis, John A.
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Yang, Rong-Sen
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Chan, Wing P.
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Wu, Chih-Hsing, Hung, Wei-Chieh, Chang, Ing-Lin, Tsai, Tsung-Ting, Chang, Yin-Fan, Mccloskey, Eugene V., Watts, Nelson B., Mcclung, Michael R., Huang, Chun-Feng, Chen, Chung-Hwan, Wu, Kun-Ling, Tsai, Keh-Sung, Chan, Ding-Cheng, Chen, Jung-Fu, Tu, Shih-Te, Hwang, Jawl-Shan, Xia, Weibo, Matsumoto, Toshio, Chung, Yoon-Sok, Cooper, Cyrus, Kanis, John A., Yang, Rong-Sen and Chan, Wing P. (2020) Pharmacologic intervention for prevention of fractures in osteopenic and osteoporotic postmenopausal women: Systemic review and meta-analysis. Bone Reports, 13, [100729]. (doi:10.1016/j.bonr.2020.100729).

Record type: Article

Abstract

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.

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More information

Accepted/In Press date: 25 October 2020
e-pub ahead of print date: 27 October 2020
Published date: December 2020

Identifiers

Local EPrints ID: 447457
URI: http://eprints.soton.ac.uk/id/eprint/447457
PURE UUID: 6290617c-10bc-49c7-86d8-7188106c2f09
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

Catalogue record

Date deposited: 11 Mar 2021 17:37
Last modified: 10 Jan 2022 02:40

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Contributors

Author: Chih-Hsing Wu
Author: Wei-Chieh Hung
Author: Ing-Lin Chang
Author: Tsung-Ting Tsai
Author: Yin-Fan Chang
Author: Eugene V. Mccloskey
Author: Nelson B. Watts
Author: Michael R. Mcclung
Author: Chun-Feng Huang
Author: Chung-Hwan Chen
Author: Kun-Ling Wu
Author: Keh-Sung Tsai
Author: Ding-Cheng Chan
Author: Jung-Fu Chen
Author: Shih-Te Tu
Author: Jawl-Shan Hwang
Author: Weibo Xia
Author: Toshio Matsumoto
Author: Yoon-Sok Chung
Author: Cyrus Cooper ORCID iD
Author: John A. Kanis
Author: Rong-Sen Yang
Author: Wing P. Chan

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