title: The efficacy and safety of bisphosphonates for osteoporosis or osteopenia in Crohn's disease: a meta-analysis.
abstract: BACKGROUND
  Crohn's disease impacts the bone health of patients and results in a high prevalence of low bone mineral density (BMD) disease such as osteoporosis and osteopenia. Bisphosphonates can reduce bone loss by inhibiting bone resorption.
  
  
  OBJECTIVE
  To assess the effectiveness and safety of bisphosphonates for osteoporosis or osteopenia in Crohn's disease.
  
  
  METHODS
  A literature search included PubMed, EMBASE, the Science Citation Index, and the Cochrane Library was conducted to identify studies up to March, 2012. Randomized controlled trials (RCTs) comparing bisphosphonates with placebo or no intervention for osteoporosis or osteopenia in adult patients with Crohn's disease were analyzed.
  
  
  RESULTS
  Five RCTs involving 423 participants were included. All patients received daily calcium and vitamin D supplementation. Overall, bisphosphonates improved hip BMD at 12 months (n = 193, MD = 0.99, 95 % CI: 0.14-1.84) compared with placebos or no intervention. No significant differences of spine BMD at both 12 months (n = 193, MD = 1.78, 95 % CI: -0.99 to 4.55) and 24 months (n = 231, MD = 0.70 %, 95 % CI: -0.48 to 1.88), hip BMD at 24 months (n = 231, MD = 0.25 %, 95 % CI: -0.65 to 1.15), new vertebral fractures (n = 117, RD = -0.01, 95 % CI: -0.08 to 0.05) or adverse events (n = 422, RR = 1.03, 95 % CI: 0.71-1.49) between bisphosphonates groups and control groups were noted. Subgroup analyses of participants treated with corticosteroid in the preceding year found no difference between two groups.
  
  
  CONCLUSIONS
  There was no evidence to support the use of bisphosphonates for osteoporosis or osteopenia in Crohn's disease. More randomized controlled clinical trials assessing the effects of bisphosphonates are needed.
authors.affiliation: Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, No. 305 East Zhongshan Road, Nanjing 210002, People's Republic of China. guozhi0809@gmail.com
authors.forename: Zhen
authors.initials: Z
authors.lastname: Guo
authors.forename: Rong
authors.initials: R
authors.lastname: Wu
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Gong
authors.forename: Weiming
authors.initials: W
authors.lastname: Zhu
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.forename: Ning
authors.initials: N
authors.lastname: Li
authors.forename: Jieshou
authors.initials: J
authors.lastname: Li
mesh_terms: D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D003424:Crohn Disease / Q000150:complications*; D004164:Diphosphonates / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006621:Hip Joint / Q000187:drug effects; D006801:Humans; D008159:Lumbar Vertebrae / Q000187:drug effects; D010024:Osteoporosis / Q000188:drug therapy* / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D016103:Spinal Fractures / Q000517:prevention & control
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates