背景:骨质疏松症引起了重大的健康问题,尤其是慢性肾病(CKD)患者。CKD破坏矿物质和骨代谢,增加骨折的风险并使骨质疏松症的管理复杂化。虽然抗骨质疏松干预措施旨在解决CKD患者的骨骼健康问题,正在进行的研究对于了解这些药物的比较疗效和安全性至关重要,特别是在不同的CKD阶段,特别是在阶段4和5。
方法:我们搜索了PubMed/MEDLINE,EMBASE,和CochraneCENTRAL进行随机对照试验,评估截至2024年6月15日在CKD中骨质疏松干预措施的有效性和安全性.分析利用了合并的比值比(OR)以及相应的95%置信区间(CI),采用综合元分析软件,3.0版。为了评估个体研究结果的异质性,我们使用了Cochran的Q统计量和I2统计量。
结果:我们分析了12项随机对照试验,涉及31,027名参与者,显示使用抗骨质疏松剂的椎骨骨折风险显着降低(特立帕肽,Denosumab,罗莫索珠单抗,雷洛昔芬)与安慰剂(合并OR,0.28[95%CI,0.22至0.36])。CKD阶段的分层显示在阶段1-3中风险较低,但在阶段4和5中没有显着降低。特立帕肽,Denosumab,Romosozumab可有效降低骨折风险,而雷洛昔芬没有显着影响。腰椎,股骨颈,和总髋部骨密度在抗骨质疏松剂之间没有显着差异(Denosumab,雷洛昔芬,Risedronate,阿仑膦酸盐,特立帕肽)和安慰剂。然而,Romosozumab在所有肾功能类别中表现出明显更大的BMD变化。在整个试验的CKD1至5期没有观察到副作用。
结论:我们的荟萃分析强调了抗骨质疏松药物在降低CKD患者椎体骨折风险方面的有效性。特别是在1-3阶段。然而,这种益处在阶段4和阶段5中并不明显,需要进一步的研究.尽管CKD患者没有副作用的报道,临床医生应仔细评估这些药物的适用性,考虑个人风险和收益。
BACKGROUND: Osteoporosis poses a significant health concern, especially for individuals with chronic kidney disease (CKD). CKD disrupts mineral and bone metabolism, heightening the risk of fractures and complicating the management of osteoporosis. While anti-osteoporotic interventions aim to address bone health in CKD patients, ongoing research is essential to understand the comparative efficacy and safety of these medications, particularly in different CKD stages, notably in stages 4 and 5.
METHODS: We searched PubMed/MEDLINE, EMBASE, and the Cochrane CENTRAL for randomized controlled trials assessing the efficacy and safety of osteoporosis interventions in CKD up to June 15, 2024. The analysis utilized the pooled odds ratio (OR) along with the corresponding 95% confidence interval (CI), employing Comprehensive Meta-Analysis software, version 3.0. To assess heterogeneity in the results of individual studies, we used Cochran\'s Q statistic and the I2 statistic.
RESULTS: We analyzed 12 randomized controlled trials involving 31,027 participants, revealing a significantly lower risk of vertebral fractures with anti-osteoporotic agents (teriparatide, denosumab, romosozumab, raloxifene) compared to placebo (pooled OR, 0.28 [95% CI, 0.22-0.36]). Stratification by CKD stages showed a lower risk in Stages 1-3 but no significant reduction in stages 4 and 5. Teriparatide, denosumab, and romosozumab were effective in lowering fracture risk, whereas Raloxifene showed no significant effect. The lumbar spine, femoral neck, and total hip BMD showed no significant differences between anti-osteoporotic agents (denosumab, raloxifene, risedronate, alendronate, teriparatide) and placebo. However, romosozumab demonstrated a significantly greater BMD change in all kidney function categories. No reported side effects were observed in CKD stages 1-5 across the trials.
CONCLUSIONS: Our meta-analysis highlights the effectiveness of anti-osteoporotic agents in lowering vertebral fracture risk in CKD patients, particularly in stages 1-3. However, this benefit is not apparent in stages 4 and 5, necessitating further research. Despite the absence of reported side effects in CKD patients, clinicians should carefully assess the suitability of these medications, considering individual risks and benefits.