The relationship between bisphosphonates and total mortality in patients with osteoporosis: A Meta-Analysis

doi:10.3877/cma.j.issn.2096-0263.2020.05.010

Abstract

Abstract:

Objective

To systematically evaluate whether clinical randomized controlled trials can demonstrate that bisphosphonates, especially zoledronic acid, are associated with reduced mortality in patients with osteoporosis.

Methods

According to the requirements of meta-analysis, CBM, CNKI, MEDLINE, PubMed, Springer, EMBASE, Wanfang, VIP and Cochrane were analyzed Library, China Science and Technology Papers Statistics and analysis network, patent database, etc. were searched to strictly evaluate the included clinical randomized controlled trials with bisphosphonates as the main intervention measures in the treatment of osteoporosis, and included effective related data. The retrieval period was from the establishment of the database to may 2020. The NOS standard was used to evaluate the quality of the literatures that met the inclusion and exclusion criteria. RR and its 95% confidence interval were used to evaluate the association strength. According to the existence of heterogeneity, the fixed effect model was used to merge the effect amount, and the single factor sensitivity analysis method was used to analyze the sensitivity.

Results

A total of 21 articles including 42, 849 subjects, 22, 605 patients in the bisphosphonate group, 855 patients died, 20, 244 patients in the placebo group and 880 deaths in the placebo group were analyzed. The correlation between bisphosphonate therapy and total mortality was 0.949 (95% CI: 0.866, 1.040, P=0.264). The correlation between alendronate and total mortality was 0.996 (95% CI: 0.705, 1.407, P=0.982), ibandronate was RR=0.802 (95% CI: 0.496, 1.298, P=0.369), risedronate was RR=0.915 (95% CI: 0.757, 1.105, P=0.354) and zoledronate was RR=0.898 (95% CI: 0.770, 1.047, P=0.168). There was no association between bisphosphonate therapy and total mortality.

Conclusion

The meta-analysis showed that bisphosphonates did not reduce the overall mortality of patients with osteoporosis.

Key words: Osteoporosis, Bisphosphonates, Total mortality

Yaling Zhang, Lin Wang, Jingxian Wang, Xinxia He. The relationship between bisphosphonates and total mortality in patients with osteoporosis: A Meta-Analysis[J]. Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition), 2020, 06(05): 304-311.

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References 56

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编号	第一作者	发表年份	药物	用药时间，年	治疗组		安慰剂组		年龄	评分
编号	第一作者	发表年份	药物	用药时间，年	死亡	全部	死亡	全部	年龄	评分
1	Liberman^[14]	1995	阿仑膦酸盐	3	3	579	2	397	64（45～80）	7
2	Black^[15]	1996	阿仑膦酸盐	3	24	1 022	21	1 005	71（55～81）	8
3	Ravn^[16]	1996	伊班膦酸盐	1	1	150	40	2 218	68（54～81）	9
4	Cummings^[17]	1998	阿仑膦酸盐	4.5	37	2 214	0	280	65（≤85）	7
5	Harris^[18]	1999	利塞膦酸盐	3	15	813	249	2 796	80（≥75）	9
6	Reginster^[19]	2000	利塞膦酸盐	3	11	407	1	30	65（<75）	6
7	McClung^[20]	2001	利塞膦酸盐	3	167	3 104	10	975	69（55～80）	8
8	Chesnut^[21]	2004	伊班膦酸盐	3	19	1 954	13	949	67（55～76）	8
9	Recker^[22]	2004	伊班膦酸盐	3	23	1 911	0	83	54（45～60）	6
10	McCloskey^[23]	2007	氯膦酸盐	3	264	2 796	3	63	51（NA）	6
11	V?lim?ki^[24]	2007	利塞膦酸盐	2	0	115	16	815	69（≤85）	7
12	Black^[25]	2007	唑来膦酸盐	3	130	3 862	17	407	71（≤85）	7
13	Lyles^[26]	2007	唑来膦酸盐	1.9	101	1 054	178	3 134	78（70～100）	9
14	Yan^[27]	2009	阿仑膦酸盐	1	0	280	0	55	66（NA）	6
15	McClung^[28]	2009	伊班膦酸盐	1	0	77	3	93	61（36～84）	6
16	Boonen^[29]	2009	利塞膦酸盐	2	2	191	112	3 852	73（65～89）	9
17	Smerud^[30]	2012	伊班膦酸盐	1	0	66	141	1 057	75（≥50）	7
18	Boonen^[31]	2012	唑来膦酸盐	2	15	588	18	611	NA（50～85）	7
19	Greenspan^[32]	2015	唑来膦酸盐	2	14	89	12	92	85（≥65）	6
20	Nakamura^[33]	2017	唑来膦酸盐	2	2	333	3	332	74（65～89）	7
21	Reid^[34]	2018	唑来膦酸盐	6	27	1 000	41	1 000	71（>65）	8

编号	第一作者	发表年份	药物	用药时间，年	治疗组		安慰剂组		年龄	评分
编号	第一作者	发表年份	药物	用药时间，年	死亡	全部	死亡	全部	年龄	评分
1	Liberman^[14]	1995	阿仑膦酸盐	3	3	579	2	397	64（45～80）	7
2	Black^[15]	1996	阿仑膦酸盐	3	24	1 022	21	1 005	71（55～81）	8
3	Ravn^[16]	1996	伊班膦酸盐	1	1	150	40	2 218	68（54～81）	9
4	Cummings^[17]	1998	阿仑膦酸盐	4.5	37	2 214	0	280	65（≤85）	7
5	Harris^[18]	1999	利塞膦酸盐	3	15	813	249	2 796	80（≥75）	9
6	Reginster^[19]	2000	利塞膦酸盐	3	11	407	1	30	65（<75）	6
7	McClung^[20]	2001	利塞膦酸盐	3	167	3 104	10	975	69（55～80）	8
8	Chesnut^[21]	2004	伊班膦酸盐	3	19	1 954	13	949	67（55～76）	8
9	Recker^[22]	2004	伊班膦酸盐	3	23	1 911	0	83	54（45～60）	6
10	McCloskey^[23]	2007	氯膦酸盐	3	264	2 796	3	63	51（NA）	6
11	V?lim?ki^[24]	2007	利塞膦酸盐	2	0	115	16	815	69（≤85）	7
12	Black^[25]	2007	唑来膦酸盐	3	130	3 862	17	407	71（≤85）	7
13	Lyles^[26]	2007	唑来膦酸盐	1.9	101	1 054	178	3 134	78（70～100）	9
14	Yan^[27]	2009	阿仑膦酸盐	1	0	280	0	55	66（NA）	6
15	McClung^[28]	2009	伊班膦酸盐	1	0	77	3	93	61（36～84）	6
16	Boonen^[29]	2009	利塞膦酸盐	2	2	191	112	3 852	73（65～89）	9
17	Smerud^[30]	2012	伊班膦酸盐	1	0	66	141	1 057	75（≥50）	7
18	Boonen^[31]	2012	唑来膦酸盐	2	15	588	18	611	NA（50～85）	7
19	Greenspan^[32]	2015	唑来膦酸盐	2	14	89	12	92	85（≥65）	6
20	Nakamura^[33]	2017	唑来膦酸盐	2	2	333	3	332	74（65～89）	7
21	Reid^[34]	2018	唑来膦酸盐	6	27	1 000	41	1 000	71（>65）	8

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