Effectiveness and safety of sequential therapy with parathyroid hormone analogues and bisphosphonates for osteoporosis:a meta-analysis
OBJECTIVE To evaluate the effectiveness and safety of sequential therapy with parathyroid hormone analogues and bisphosphonates for osteoporosis.METHODS PubMed,Embase,the Cochrane Library,Web of Science,China National Knowledge Infrastructure,VIP,Wanfang data,and SinoMed were searched in both English and Chinese databases from their inception to March 25,2024.Two researchers independently conducted literature searches,screening,and data extraction.Review Manager 5.4 software was used for the meta-analysis.Subgroup analyses and sensitivity analyses were performed based on different medication sequences in the treatment group to account for potential sources of heterogeneity.RESULTS A total of 7 randomized controlled trials involving 2 461 participants were included,with 1 215 in the treatment group and 1 246 in the control group.The meta-analysis results showed that the treatment group using sequential therapy with parathyroid hormone analogues and bisphosphonates had superior effects on improving bone mineral density at the lumbar spine[SMD=0.90,95％CI(0.44,1.35),P＜0.001],total hip[SMD=0.68,95％CI(0.14,1.21),P=0.01],and femoral neck[SMD=0.45,95％CI(0.04,0.86),P=0.03]compared to the control group.It also significantly outperformed the control group in reducing the incidence of fractures post-treatment[OR=0.72,95％CI(0.54,0.97),P=0.03].No significant difference was noted in the incidence of adverse reactions between the two groups[OR=1.21,95％CI(0.99,1.46),P=0.06].Subgroup analysis based on intervention measures in the treatment group showed that switching from bisphosphonates to parathyroid hormone analogues[SMD=0.56,95％CI(0.09,1.03),P=0.02]or switching from parathyroid hormone analogues to bisphosphonates[SMD=0.97,95％CI(0.49,1.46),P＜0.001]both significantly potentiated lumbar spine bone mineral density compared to the control group.Switching from bisphosphonates to parathyroid hormone analogues also significantly promoted total hip bone mineral density compared to the control group[SMD=0.66,95％CI(0.18,1.13),P=0.007].Sensitivity analysis indicated that the results of this study were robust.CONCLUSIONS Sequential therapy with parathyroid hormone analogues and bisphosphonates can be recommended as an effective treatment for patients with osteoporosis,with good safety profiles.The medication sequences should be individually adjusted based on the patient's particular situation and the different responses of various skeletal sites.
parathyroid hormone analoguesdiphosphonatessequential therapyosteoporosisbone mineral density
万方数据
维普
