title: Efficacy and safety of medical therapy for low bone mineral density in patients with Crohn disease: A systematic review with network meta-analysis.
abstract: BACKGROUND
  Low bone mineral density (BMD) is a frequent complication of inflammatory bowel disease (IBD), particularly in patients with Crohn disease (CD). The aim of our study is to determine the efficacy and safety of different drugs used to treat low BMD in patients with CD.
  
  
  METHODS
  PUBMED/MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched for eligible studies. A random-effects model within a Bayesian framework was applied to compare treatment effects as standardized mean difference (SMD) with their corresponding 95% credible interval (CrI), while odds ratio (OR) was applied to compare adverse events with 95% CrI. The surface under the cumulative ranking area (SUCRA) was calculated to make the ranking of the treatments for outcomes.
  
  
  RESULTS
  Twelve randomized controlled trials (RCTs) were eligible. Compared with placebo, zoledronate (SMDs 2.74, 95% CrI 1.36-4.11) and sodium-fluoride (SMDs 1.23, 95% CrI 0.19-2.26) revealed statistical significance in increasing lumbar spine BMD (LSBMD). According to SUCRA ranking, zoledronate (SUCRA = 2.5%) might have the highest probability to be the best treatment for increasing LSBMD in CD patients among all agents, followed by sodium-fluoride (27%). For safety assessment, the incidence of adverse events (AEs) demonstrated no statistical difference between agents and placebo. The corresponding SUCRA values indicated that risedronate (SUCRA = 77%) might be the most safe medicine for low BMD in CD patients and alendronate ranked the worst (SUCRA = 16%).
  
  
  CONCLUSIONS
  Zoledronate might have the highest probability to be the best therapeutic strategy for increasing LSBMD. For the safety assessment, risedronate showed the greatest trend to decrease the risk of AEs. In the future, more RCTs with higher qualities are needed to make head-to-head comparison between 2 or more treatments.
authors.affiliation: Department of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Xiaojing
authors.initials: X
authors.lastname: Zhao
authors.forename: Changcheng
authors.initials: C
authors.lastname: Zhou
authors.forename: Han
authors.initials: H
authors.lastname: Chen
authors.forename: Jingjing
authors.initials: J
authors.lastname: Ma
authors.forename: Yunjuan
authors.initials: Y
authors.lastname: Zhu
authors.forename: Peixue
authors.initials: P
authors.lastname: Wang
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.forename: Haiqin
authors.initials: H
authors.lastname: Ma
authors.forename: Hongjie
authors.initials: H
authors.lastname: Zhang
mesh_terms: D019386:Alendronate / Q000627:therapeutic use; D001499:Bayes Theorem; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001851:Bone Diseases, Metabolic / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology; D003424:Crohn Disease / Q000150:complications* / Q000473:pathology; D004164:Diphosphonates / Q000627:therapeutic use; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use; D000068296:Risedronic Acid / Q000627:therapeutic use; D012969:Sodium Fluoride / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid; D012969:Sodium Fluoride; D000068296:Risedronic Acid; D019386:Alendronate