BackgroundLong-term usage of glucocorticoids results in a loss of bone mass and a higher risk of fracture, and the most common cause of secondary osteoporosis is glucocorticoid-induced osteoporosis (GIOP). For preventing GIOP, bisphosphonate (BP) is widely used. However, analysis on BP’s effect on the prevention of re-fracture is insufficient. The purpose of the present study is to evaluate the comparative treatment effect and prevention of re-fracture according to the type of BP in GIOP as the basis for a reliable clinical strategy for patients.Methods and analysisWe will search electronic databases of the PubMed, Cochrane Library and EMBASE using a comprehensive search strategy in December 2021 with no language restriction. Randomised controlled trials (RCTs), quasi-RCTs, controlled trials and cohort studies evaluating the effectiveness of BP to the patients with GIOP will be included in this study. The primary outcome will be the incidence of hip, vertebral and other fractures. The secondary outcome will include percentage changes on the bone mineral density and incidence of re-fracture. Assessing risk of bias for included studies is done using the Cochrane Risk of Bias tool and Risk Of Bias In Non-randomized Studies–of Intervention tool. If quantitative synthesis is possible, a meta-analysis will be performed. A subgroup analysis will be conducted to compare re-fracture rate on the patients with GIOP who experience previous fractures. This study’s result will provide evidence for the effectiveness of BP in the prevention of re-fracture on patients with GIOP.Ethics and disseminationThe results will be disseminated through publishing in a peer-reviewed journal or public presentations. Ethical approval is not required as this is a systematic review of publicly available data.PROSPERO registration numberCRD42022343787.

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IntroductionPartial nephrectomy is recommended over radical nephrectomy for the surgical treatment of patients with stage cT1 renal cancer in multiple guidelines. The objective of this study is to examine the cost effectiveness of robot-assisted partial nephrectomy (RAPN), compared with open radical nephrectomy (ORN) or laparoscopic radical nephrectomy (LRN), for treating stage cT1 renal cancer in Korea.MethodsA Markov model was applied in patients with cT1 renal cancer that consisted of the following six health states: post-surgery, normal, chronic kidney disease (CKD), dialysis, death from renal failure, and natural death. Utilities and transition probabilities were obtained from systematic literature reviews. Costs were obtained from the current Korean National Health Insurance fee schedule, the Korean medical literature, and 2016 Health Insurance Review and Assessment Service inpatient claims data. Univariate and probabilistic sensitivity analyses were performed to check for uncertainty.ResultsRAPN was the dominant treatment, costing KRW 2.1 to 3.6 million (USD 1,700 to 2,900) less than the comparators while providing 0.45 to 0.61 more utility. Univariate sensitivity analysis showed that the most sensitive parameter was the relative risk reduction of CKD after partial nephrectomy. The sensitivity analysis also showed that the acceptability of RAPN at a cost-effectiveness threshold of KRW 30.5 million was high relative to both comparators (85.9% against LRN and 78.9% against ORN).ConclusionsThough there might be uncertainties in non-Korean utility data and some transition probabilities derived from Japanese data, the current study suggested that partial nephrectomy is a more cost-effective option than ORN or LRN in Korea for patients with stage cT1 renal cancer.