CAJ | 학술논문

目的：比较双膦酸盐类抗骨质疏松药物的相对疗效与安全性。方法检索PubMed及Cochrane Database of Systematic Review，收集有关双膦酸盐有效性及安全性的Meta分析及网络Meta分析，并手工检索获得双膦酸盐之间直接比较的随机对照研究，对双膦酸盐直接比较及间接比较证据进行描述性分析。结果共纳入Meta分析17篇，包括双膦酸盐之间直接比较的Meta分析1篇，不同双膦酸盐与安慰剂对比的Meta分析10篇，双膦酸盐间相对作用比较的网络Meta分析6篇。手工检索获得双膦酸盐之间直接比较的随机对照研究8篇，直接比较结果显示，双膦酸盐间在骨折预防及安全性上差异无统计学意义（ P＞0．05）。间接比较结果显示，在预防腰椎、髋部、腕部、非腰椎（非髋部）骨折发生方面，分别为唑来膦酸、阿仑膦酸钠或唑来膦酸、阿仑膦酸钠、利塞膦酸钠疗效最佳。最常见导致胃肠道不良事件、恶心、因不良事件导致停药的药物，分别为唑来膦酸、唑来膦酸、依替膦酸二钠。结论双膦酸盐用于抗骨质疏松治疗是有效、安全的。在多种双磷酸盐中，唑来膦酸预防多种骨折疗效最佳，但其胃肠道不良事件也相对较多。目前双膦酸盐预防骨折直接比较及间接比较的证据质量较低，还需要设计良好的临床研究支持上述结论。
목적：비교쌍련산염류항골질소송약물적상대료효여안전성。방법검색PubMed급Cochrane Database of Systematic Review，수집유관쌍련산염유효성급안전성적Meta분석급망락Meta분석，병수공검색획득쌍련산염지간직접비교적수궤대조연구，대쌍련산염직접비교급간접비교증거진행묘술성분석。결과공납입Meta분석17편，포괄쌍련산염지간직접비교적Meta분석1편，불동쌍련산염여안위제대비적Meta분석10편，쌍련산염간상대작용비교적망락Meta분석6편。수공검색획득쌍련산염지간직접비교적수궤대조연구8편，직접비교결과현시，쌍련산염간재골절예방급안전성상차이무통계학의의（ P＞0．05）。간접비교결과현시，재예방요추、관부、완부、비요추（비관부）골절발생방면，분별위서래련산、아륜련산납혹서래련산、아륜련산납、리새련산납료효최가。최상견도치위장도불량사건、악심、인불량사건도치정약적약물，분별위서래련산、서래련산、의체련산이납。결론쌍련산염용우항골질소송치료시유효、안전적。재다충쌍린산염중，서래련산예방다충골절료효최가，단기위장도불량사건야상대교다。목전쌍련산염예방골절직접비교급간접비교적증거질량교저，환수요설계량호적림상연구지지상술결론。
Objective To evaluate the comparative effectiveness and safety of bisphosphonates.Methods PubMed and Cochrane Database of Systematic Review were electronically searched for Meta -analysis and network Meta-analysis about the effectiveness and safety of bisphospho-nates.The randomized controlled trials ( RCTs ) comparing different bi-sphosphonates were manually searched.We then complete the descriptive analysis about the direct and indirect comparison between bisphospho-nates.Results Seventeen Meta-analyses were included, including 1 Meta-analysis comparing different bisphosphonates, 10 Meta-analyses comparing bisphosphonates and placebo, and 6 network Meta-analyses. The results of direct comparison showed that there was no significant difference between different bisphosphonates in effectiveness and safety. The results of indirect comparison showed that zoledronic acid, alendr-onate or zoledronic acid, alendronate, risedronate ranked first in preven-ting vertebral fracture, hip fracture, wrist, non -hip -non -vertebral fracture among different bisphosphonates, respectively.Zoledronic acid, zoledronic acid, etidronate ranked highest in causing any gastrointestinal adverse events, nausea, and discontinuation due to adverse drug reactions among different bisphosphonates, respective-ly.Conclusion Bisphosphonates are effective and safe medications for treating osteoporosis.Although zoledronic acid ranked highest in preventing fracture, it was also more likely to cause gastrointestinal adverse events.However, the quality of a body of evidence comparing different bisphosphonates is low.More well -designed clinical studies are needed to support above conclusion.