title: The efficacy of statins in preventing glucocorticoid-related osteonecrosis in animal models: A meta-analysis.
abstract: OBJECTIVE
  The primary purpose of this meta-analysis was to determine whether statin usage could reduce the risk of glucocorticoid-related osteonecrosis in animal models.
  
  
  METHODS
  A systematic literature search up to May 2015 was carried out using the PubMed, Ovid, EBM reviews, ISI Web of Science, EBSCO, CBM, CNKI databases with the term and boolean operators: statins and osteonecrosis in all fields. Risk ratio (RR), as the risk estimate of specific outcome, was calculated along with 95% confidence intervals (CI). The methodological quality of individual studies was assessed using a quantitative tool based on the updated Stroke Therapy Academic Industry Roundtable (STAIR) recommendations.
  
  
  RESULTS
  A total of 11 eligible studies were included according to predetermined criteria. The pooled data demonstrated that animals with statin usage, either alone or combined with other treatments, were at a decreased risk of developing glucocorticoid-related osteonecrosis (RR = 2.06, 95% confidence interval (CI) 1.71 to 2.50). Moreover, subgroup analysis revealed that compared with statins alone, statins combined with other treatments significantly decreased the risk of osteonecrosis (RR = 1.23, 95% CI 1.02 to 1.47). However, we could find no significant risk difference for different gender, or for different time points.
  
  
  CONCLUSIONS
  The present study suggests that statins combined with other treatments are efficient in preventing the development of glucocorticoid-related osteonecrosis in animals. These results might shed light on clinical practice when glucocorticoids are prescribed, and could be further investigated in high-quality clinical trials.Cite this article: Z. Yang, H. Liu, D. Li, X. Xie, T. Qin, J. Ma, P. Kang. The efficacy of statins in preventing glucocorticoid-related osteonecrosis in animal models: A meta-analysis. Bone Joint Res 2016;5:393-402. DOI: 10.1302/2046-3758.59.2000500.
authors.affiliation: Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Rehabilitation Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China.
authors.forename: H
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: D
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: X
authors.initials: X
authors.lastname: Xie
authors.affiliation: Chinese Evidence-Based Medicine Centre/Cochrane Center, West China Hospital, Chengdu, China.
authors.forename: T
authors.initials: T
authors.lastname: Qin
authors.affiliation: Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: J
authors.initials: J
authors.lastname: Ma
authors.affiliation: Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, China pdkang512@163.com.
authors.forename: P
authors.initials: P
authors.lastname: Kang
keywords: Animal model; Glucocorticoid; Osteonecrosis; Prevention; Statins