Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs
Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs
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DOI：
10.1016/s0002-9343(01)01124-x
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发表时间：
2002-03-01
影响因子：
5.9
通讯作者：
Black, DM
中科院分区：
文献类型：
--
作者：
Cummings, SR;Karpf, DB;Black, DM
目的：评估骨质疏松症抗吸收治疗随机试验中观察到的骨量改善对椎体骨折风险降低的影响。方法：经过系统检索，我们对12项试验进行了荟萃分析，以描述绝经后妇女脊柱骨矿物质密度的改善与椎体骨折风险降低之间的关系。我们还使用逻辑模型来估计骨折干预试验中阿仑膦酸钠观察到的椎体骨折风险降低的比例，这是由于骨密度的改善。结果：在12项试验中，脊柱骨密度改善1%与椎体骨折相对风险（RR）降低0.03相关（95%可信区间[CI]: 0.02至0.05）。由于骨密度的改善，风险的降低比预期的要大；例如，该模型估计，基于骨矿物质密度的改善，预计可使骨折风险降低20% （RR = 0.80）的治疗方法，实际上可使骨折风险降低约45% （RR = 0.55）。在骨折干预试验中，阿仑膦酸钠治疗椎体骨折风险降低的16% （95% CI: 11% - 27%）是因为脊柱骨密度的改善。结论：抗骨吸收药物治疗期间脊柱骨密度的改善是可预测的，但只是观察到的椎体骨折风险降低的一小部分。(C)2002年由摘录医学公司。
PURPOSE: To estimate how much the improvement in bone mass accounts for the reduction in risk of vertebral fracture that has been observed in randomized trials of antiresorptive treatments for osteoporosis.METHODS: After a systematic search, we conducted a meta-analysis of 12 trials to describe the relation between improvement in spine bone mineral density and reduction in risk of vertebral fracture in postmenopausal women. We also used logistic models to estimate the proportion of the reduction in risk of vertebral fracture observed with alendronate in the Fracture Intervention Trial that was due to improvement in bone mineral density.RESULTS: Across the 12 trials, a 1% improvement in spine bone mineral density was associated with a 0.03 decrease (95% confidence interval [CI]: 0.02 to 0.05) in the relative risk (RR) of vertebral fracture. The reductions in risk were greater than predicted from improvement in bone mineral density; for example, the model estimated that treatments predicted to reduce fracture risk by 20% (RR = 0.80), based on improvement in bone mineral density, actually reduce the risk of fracture by about 45% (RR = 0.55). In the Fracture Intervention Trial, improvement in spine bone mineral density explained 16% (95% CI: 11% to 27%) of the reduction in the risk of vertebral fracture with alendronate.CONCLUSION: Improvement in spine bone mineral density during treatment with antiresorptive drugs accounts for a predictable but small part of the observed reduction in the risk of vertebral fracture. (C)2002 by Excerpta Medica, Inc.