Alendronate prevents glucocorticoid-induced osteoporosis in patients with rheumatic diseases

Kan, Shun-Li; Yuan, Zhi-Xin; Li, Yan; Ai, Jie; Xu, Hong; Sun, Jun; Feng, Shiqing

doi:10.1097/md.0000000000003990

Cited by 17 publications

(14 citation statements)

References 28 publications

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“…Alendronate has a significant effect on the increase in bone mineral density in the spine and femoral neck, but there is no significant difference on the fracture and the adverse reaction compared with the control group. [ 40 ] In Allen's paper, the meta-analysis aimed at Bisphosphonate effects, including not only alendronate, but also pamidronate, etidronate, and other drug was summarized and analyzed. At the lumbar spine, there is an absolute increase in BMD of 3.5% with bisphosphonates.…”

Section: Discussionmentioning

confidence: 99%

Effects of alendronate for treatment of glucocorticoid-induced osteoporosis

et al. 2018

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Background:Alendronate has been used to prevent or treat glucocorticoid-induced osteoporosis (GIO), data regarding its efficacy are inconsistent. We conducted the current systematic review and meta-analysis to evaluate both efficacy and safety of alendronate in the treatment of GIO.Methods:PubMed, Embase, the Cochrane Controlled Trials Registry, and the China Academic Journal Network Publishing Databases were searched up through March 1, 2018. Randomized controlled trials (RCTs) involving patients which received alendronate treatment were included. Outcome measures were bone mineral density (BMD) changes, bone fractures, and adverse reactions. Data from the individual studies were pooled using random or fixed effect models based on heterogeneity. Effect size was reported as standardized mean differences (SMD) for continuous outcomes and pooled odds ratios (OR) for dichotomous outcomes, with 95% confidence interval (CI).Results:Overall, 10 studies involving 1002 patients were included in the present investigation. Alendronate treatment significantly increased BMD of the lumbar spine and femoral neck during 6 to 24 months. These beneficial effects were apparent at 12 months after treatment for the lumbar spine but not the femoral neck BMD. Alendronate treatment did not significantly change fracture risk nor induce significant differences in adverse gastrointestinal effects.Conclusion:Alendronate significantly increases BMD of the lumbar spine and femoral neck in patients with GIO, but does not appear to reduce the risk of fractures. As relatively insufficient data regarding the GIO fracture incidence has been reported, more RCTs need to be carried out to determine the efficacy of alendronate in the prevention of GIO fracture.

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Section: Discussionmentioning

confidence: 99%

Effects of alendronate for treatment of glucocorticoid-induced osteoporosis

et al. 2018

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“…On one hand, most studies focused on BPs of one type, and only a few articles summarized their overall efficacy. On the other hand, nearly no meta-analysis or systematic review analysed the effect of BPs and other drugs on Eastern Asians [7,8,23,24]. Considering the ethnic difference in the efficacy of BPs and vitamin D, previous results may lead to failure when the studied drugs are administered to Eastern Asians.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Glucocorticoid-Induced Osteoporosis with Bisphosphonates Alone, Vitamin D Alone or a Combination Treatment in Eastern Asians: A Meta-Analysis

Wang

2019

CPD

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Background: Glucocorticoid (GC)-induced osteoporosis and fractures have become a serious problem for Eastern Asians. Bisphosphonates (BPs), vitamin D and a combination treatment are effective methods to prevent and treat GC-induced osteoporosis. Objective: The study aimed to compare the efficacy of BPs, vitamin D and a combination treatment for preventing and managing GC-induced osteoporosis in Eastern Asians. Methods: A comprehensive search in the PubMed, EMBASE, Web of Science and Cochrane CENTRAL databases was undertaken for randomized controlled trials (RCTs) on the effect of BPs, vitamin D and the combination treatment on GCs-induced osteoporosis in Eastern Asian populations. Primary outcome measures were the change in bone mineral density (BMD) and bone turnover markers. The final search was performed in March 2019. Results: Nine RCTs were included. A total of 545 patients met the inclusion criteria. Compared with vitamin D, BPs and the combination treatment significantly alleviated osteoporosis of the spine and femoral neck in Eastern Asians with GC-induced osteoporosis. At the same time, the change in serum bone-specific alkaline phosphatase (BAP) and serum C-telopeptide of type I collagen (CTX) levels was observed to be significantly less with BPs and the combination treatment with vitamin D alone. No significant difference was found between BPs and the combination treatment in the markers mentioned above. Conclusion: Compared with vitamin D alone, BPs alone and the combination treatment were significantly effective on Eastern Asians with GC-induced osteoporosis. Compared with the combination treatment, BPs alone were observed to be effective enough to increase the BMDs of the spine and femoral neck on both sides and thus prevent GC-induced osteoporosis in Eastern Asians.

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“…Alendronate reduced nonvertebral fracture risk (RR 0.83, 95% CI 0.72–0.96, I 2 0%) and hip fracture risk (RR 0.66, 95% CI 0.53–0.82, I 2 0%) in the primary prevention subgroup, and reduced nonvertebral fracture risk (RR 0.58, 95% CI 0.50–0.68, I 2 0%) and hip fracture risk (RR 0.43, 95% CI 0.30–0.60, I 2 0%) in the secondary prevention subgroup. Similarly, a Cochrane review [ 38 ] confirmed the anti-fracture efficacy of alendronate for the primary and secondary prevention of postmenopausal osteoporosis, 1 other Cochrane review [ 7 ] confirmed the anti-fracture efficacy of oral bisphosphonates as a whole in patients with GIOP, and 2 other meta-analyses [ 10 , 11 ] confirmed the effectiveness of alendronate in increasing BMD in patients with GIOP. Consistent with the finding about the safety and tolerability of alendronate in this study, the 4 meta-analyses [ 7 , 10 , 11 , 38 ] also demonstrated alendronate had the same safety and tolerability as control treatment.…”

Section: Discussionmentioning

confidence: 97%

“…Clinicians and patients need to know what probably affects the efficacy of alendronate in patients receiving long-term GCs and some specific conditions in which alendronate is not able to reduce GI fractures. Several meta-analyses [ 7 – 11 ] were conducted to aim to assess the effectiveness of alendronate in patient with GIOP. However, all of these studies failed to explore the factors affecting alendronate's efficacy and failed to find out specific patients for whom alendronate was not suitable.…”

Section: Introductionmentioning

confidence: 99%

Meta-regression analysis of the efficacy of alendronate for prevention of glucocorticoid-induced fractures

Qiu¹,

Ding

Zhang³

et al. 2020

Medicine

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Background: What affects the efficacy of alendronate for prevention of glucocorticoid-induced (GI) fractures remains unclear. We aimed to explore the factors affecting alendronate's efficacy, and further identify subgroup effects of alendronate in preventing GI fractures. Methods: We searched 3 databases. Random-effects meta-analysis was conducted to synthesize risk ratio (RR) and 95% confidence interval (CI) for each endpoint. Meta-regression analysis was used to explore sources of heterogeneity, and subgroup analysis was used to address heterogeneity and evaluate subgroup effects. We detected publication bias using funnel plots and Egger tests. Results: We included 13 papers from 12 unique studies involving 46431 participants. Glucocorticoid (GC) dosage ( P = .053) and proportion of previous vertebral fracture (PVF) ( P = .047) were probably 2 sources of heterogeneity in meta-analysis for vertebral fractures, while GC duration ( P = .020) was probably 1 for nonvertebral fractures. Alendronate reduced vertebral fractures in the high dosage subgroup (RR 0.61, 95% CI 0.44–0.86), but didn’t in the low dosage subgroup (RR 1.56, 95% CI 0.20–12.02). Alendronate reduced vertebral fractures (RR 0.53, 95% CI 0.40–0.68) in the subgroup of PVF proportion <5%, but didn’t (RR 0.76, 95% CI 0.42–1.37) in the subgroup of this proportion ≥5%. Alendronate reduced nonvertebral and hip fractures, whether in primary or in secondary prevention subgroup. Conclusions: The findings in our study support that alendronate is used for the primary and secondary prevention of GI fractures, but do not support that alendronate is recommended as a first-line agent for patients receiving a low dose of GCs or patients with PVF.

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Alendronate prevents glucocorticoid-induced osteoporosis in patients with rheumatic diseases

Abstract: Supplemental Digital Content is available in the text

Cited by 17 publications

References 28 publications

Effects of alendronate for treatment of glucocorticoid-induced osteoporosis

Effects of alendronate for treatment of glucocorticoid-induced osteoporosis

Treatment of Glucocorticoid-Induced Osteoporosis with Bisphosphonates Alone, Vitamin D Alone or a Combination Treatment in Eastern Asians: A Meta-Analysis

Meta-regression analysis of the efficacy of alendronate for prevention of glucocorticoid-induced fractures

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