title: Bisphosphonates for the prevention and treatment of osteoporosis in patients with rheumatic diseases: a systematic review and meta-analysis.
abstract: BACKGROUND
  While bisphosphonates (BPs) are commonly used in clinical treatment for osteoporosis, their roles on osteoporosis treatment for rheumatic patients remain unclear. We performed a meta-analysis to evaluate the efficacy of BPs on fractures prevention and bone mass preserving in rheumatic patients.
  
  
  RESULTS
  We searched PubMed, EmBase, and the Cochrane Central Register of Controlled Trials for relevant literatures with a time limit of Jan. 6, 2012. All randomized clinical trials of BPs for adult rheumatic patients with a follow-up of 6 months or more were included. We calculated relative risks (RRs) for fractures and weighted mean difference (WMD) for percent change of bone mineral density (BMD). Twenty trials were included for analysis. The RR in rheumatic patients treated with BPs was 0.61 (95%CI [0.44, 0.83], P = 0.002) for vertebral fractures, and 0.49 (95%CI [0.23, 1.02], P = 0.06) for non-vertebral fractures. The WMD of BMD change in the lumbar spine was 3.72% (95%CI [2.72, 4.72], P<0.001) at 6 months, 3.67% (95%CI [2.84, 4.50], P<0.001) at 12 months, 3.64% (95%CI [2.59, 4.69], P<0.001) at 24 months, and 5.87% (95%CI [4.59, 7.15], P<0.001) at 36 months in patients using BPs, as compared with those treated with calcium, vitamin D or calcitonin. In subgroup analyses, rheumatic patients using BPs for osteoporosis prevention had greater WMD than those using BPs for treating osteoporosis at 6 months (4.53% vs. 2.73%, P = 0.05) and 12 months (4.93% vs. 2.91%, P = 0.01).
  
  
  CONCLUSIONS
  In both short-term and middle-term, BPs can preserve bone mass and reduce the incidence of vertebral fractures in rheumatic patients, mainly for those who have GC consumption. The efficacy of BPs is better when using BPs to prevent rather than to treat osteoporosis in rheumatic patients.
authors: Spine lab, Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors: Zhiyun
authors: Z
authors: Feng
authors: Shumei
authors: S
authors: Zeng
authors: Yue
authors: Y
authors: Wang
authors: Zhiyun
authors: Z
authors: Zheng
authors: Zhong
authors: Z
authors: Chen
mesh_terms: D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002116:Calcitonin / Q000008:administration & dosage; D002118:Calcium / Q000008:administration & dosage; D016206:Databases, Bibliographic; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects; D006801:Humans; D008159:Lumbar Vertebrae / Q000187:drug effects* / Q000293:injuries / Q000473:pathology; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D016032:Randomized Controlled Trials as Topic; D012216:Rheumatic Diseases / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D016103:Spinal Fractures / Q000188:drug therapy / Q000473:pathology / Q000517:prevention & control*; D014807:Vitamin D / Q000008:administration & dosage
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D005938:Glucocorticoids; D014807:Vitamin D; D002116:Calcitonin; D002118:Calcium