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

Abstract

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.

The therapeutic effect to eldecalcitol + bisphosphonate is superior to bisphosphonate alone in the treatment of osteoporosis: a meta-analysis

“…Increase in BMD by BP + ELD-treated osteoporotic patients is associated with the serum calcium level within the reference interval [ 16 ]. However, some studies indicated that compared with the BP-associated combination therapy, the BP treatment alone significantly increased the therapy effect in osteoporotic patients [ 17 – 19 ]. The clinical advantages of BP alone in the treatment of osteonecrosis compared with combined therapy have also been confirmed by multi-center studies [ 20 ].…”

Pharmacological Interventions for Glucocorticoid-Induced Osteoporosis: An Umbrella Review

“…After double checking and reading the title and abstract of the results, we included 38 SRs for full-text reading. After excluding a narrative review, a network meta-analysis, and animal experiments, 6 SRs [17][18][19][20][21][22]…”

“…Primary outcome bMD of the lumbar spine (LSbMD) LSBMD was reported in six SRs [17][18][19][20][21][22]. Compared with low-dose BPs, standard-dose BPs improved the LSBMD (MD: 0.95 %, 95 % CI: 0.37 % to 1.53 %, p < 0.001).…”

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“…According to the evaluation results of the AMSTAR-2 tool, the 6 SRs included in this review included 2 high-quality [17,18], 2 low-quality [20,21], and 2 critically low-quality SRs [19,22]. The specific details of the methodological quality evaluation are shown in ▶Table 2.…”