Etidronate for treating and preventing postmenopausal osteoporosis.
OBJECTIVE
To systematically review the efficacy of etidronate on bone density, fractures and toxicity in postmenopausal women.


METHODS
We searched MEDLINE from 1966 to December 1998, examined citations of relevant articles, and the proceedings of international osteoporosis meetings. We contacted osteoporosis investigators to identify additional studies, primary authors, and pharmaceutical industry sources for unpublished data.


METHODS
We included thirteen trials (with 1010 participants) that randomized women to etidronate or an alternative (placebo or calcium and/or vitamin D) and measured bone density for at least one year.


METHODS
For each trial, three independent reviewers assessed the methodological quality and abstracted data.


RESULTS
The data suggested a reduction in vertebral fractures with a pooled relative risk of 0.60% (95% CI 0.41 to 0.88). There was no effect on non-vertebral fractures (pooled relative risk 1.00, (95% CI 0.68 to 1.42)). Etidronate, relative to control, increased bone density after three years of treatment in the lumbar spine by 4.27% (95% CI 2.66 to 5.88), in the femoral neck by 2.19% (95% CI 0.43, 3.95) and in the total body by 0.97% (95% CI 0.39, 1.55). Effects were larger at 4 years, though the number of patients followed was much smaller.


CONCLUSIONS
Etidronate increases bone density in the lumbar spine and femoral neck. The pooled estimates of fracture reduction with etidronate are consistent with a reduction in vertebral fractures, but no effect on non-vertebral fractures.
Cranney
A
A
Medicine - Rheumatology, Ottawa Hospital, Civic Campus, 461, 737 Parkdale Ave, Ottawa, Ontario, Canada, K1Y 1J8. acranney@ottawahospital.on.ca
Welch
V
V
Adachi
J D
JD
Guyatt
G
G
Krolicki
N
N
Griffith
L
L
Shea
B
B
Tugwell
P
P
Wells
G
G
D015519:Bone Density / Q000187:drug effects; D012968:Etidronic Acid / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy* / Q000517:prevention & control; D016103:Spinal Fractures / Q000209:etiology
D012968:Etidronic Acid