Abstract
BackgroundWhile bisphosphonates (BPs) are commonly used in clinical treatment for osteoporosis, their roles on osteoporosis treatment for rheumatic patients remain unclear. We performed a meta-analysis to evaluate the efficacy of BPs on fractures prevention and bone mass preserving in rheumatic patients.Methodology/Principal FindingsWe searched PubMed, EmBase, and the Cochrane Central Register of Controlled Trials for relevant literatures with a time limit of Jan. 6, 2012. All randomized clinical trials of BPs for adult rheumatic patients with a follow-up of 6 months or more were included. We calculated relative risks (RRs) for fractures and weighted mean difference (WMD) for percent change of bone mineral density (BMD). Twenty trials were included for analysis. The RR in rheumatic patients treated with BPs was 0.61 (95%CI [0.44, 0.83], P = 0.002) for vertebral fractures, and 0.49 (95%CI [0.23, 1.02], P = 0.06) for non-vertebral fractures. The WMD of BMD change in the lumbar spine was 3.72% (95%CI [2.72, 4.72], P<0.001) at 6 months, 3.67% (95%CI [2.84, 4.50], P<0.001) at 12 months, 3.64% (95%CI [2.59, 4.69], P<0.001) at 24 months, and 5.87% (95%CI [4.59, 7.15], P<0.001) at 36 months in patients using BPs, as compared with those treated with calcium, vitamin D or calcitonin. In subgroup analyses, rheumatic patients using BPs for osteoporosis prevention had greater WMD than those using BPs for treating osteoporosis at 6 months (4.53% vs. 2.73%, P = 0.05) and 12 months (4.93% vs. 2.91%, P = 0.01).Conclusions/SignificanceIn both short-term and middle-term, BPs can preserve bone mass and reduce the incidence of vertebral fractures in rheumatic patients, mainly for those who have GC consumption. The efficacy of BPs is better when using BPs to prevent rather than to treat osteoporosis in rheumatic patients.
Highlights
Rheumatic diseases are inflammatory conditions which may cause significant swelling and pain in joints and muscles, resulting in a decreased life quality or even disability
While low dose GC consumption was reportedly inadequate to induce significant osteoporosis clinically [3], the bone loss rates could as high as 13.9% per year in patients treated with high dosage of GC [4,5]
These terms were used in combination with each of the following medical headings: rheumatic diseases, rheumatoid arthritis, RA, psoriatic arthritis, PsA, systemic lupus erythematosus, SLE, ankylosing spondylitis, AS, polymyositis, dermatomyositis, systemic sclerosis, vasculitis syndrome, still’s disease, polymyalgia rheumatic, PMR, systemic sclerosis, Sjogren’s syndrome, and Behcet’s disease
Summary
Rheumatic diseases are inflammatory conditions which may cause significant swelling and pain in joints and muscles, resulting in a decreased life quality or even disability. As rheumatic-related osteoporosis and fractures may substantially deteriorate the original rheumatic illness and increase the cost of health care [2], the prevention and treatment of osteoporosis are important clinical issues in managing rheumatic diseases. While low dose GC consumption (prednisolone, ,7.5 mg/day) was reportedly inadequate to induce significant osteoporosis clinically [3], the bone loss rates could as high as 13.9% per year in patients treated with high dosage of GC (prednisolone, .7.5 mg/day) [4,5]. Some other studies reported that patients taking low dosage of GC had an increased risk of both vertebral and non-vertebral fractures [6,7]. We performed a meta-analysis to evaluate the efficacy of BPs on fractures prevention and bone mass preserving in rheumatic patients
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