title: Etidronate for treating and preventing postmenopausal osteoporosis.
abstract: 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osteoporosis investigators to identify additional studies, primary authors, and pharmaceutical industry sources for unpublished data.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.
authors.affiliation: Medicine - Rheumatology, Ottawa Hospital, Civic Campus, 461, 737 Parkdale Ave, Ottawa, Ontario, Canada, K1Y 1J8. acranney@ottawahospital.on.ca
authors.forename: A
authors.initials: A
authors.lastname: Cranney
authors.forename: V
authors.initials: V
authors.lastname: Welch
authors.forename: J D
authors.initials: JD
authors.lastname: Adachi
authors.forename: G
authors.initials: G
authors.lastname: Guyatt
authors.forename: N
authors.initials: N
authors.lastname: Krolicki
authors.forename: L
authors.initials: L
authors.lastname: Griffith
authors.forename: B
authors.initials: B
authors.lastname: Shea
authors.forename: P
authors.initials: P
authors.lastname: Tugwell
authors.forename: G
authors.initials: G
authors.lastname: Wells
mesh_terms: 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
chemical_list: D012968:Etidronic Acid