Nurmuhammet TAŞ

Osteoporoz için Çeşitli İlaçlı Tedavi Seçeneklerinin Etkinliği Üzerine Bir Meta-analiz

Bu meta-analizin amacı, osteoporoz için farklı tedavi seçeneklerini gözden geçirmek ve değerlendirmek, etkinliklerini incelemektir. Özellikle, osteoporoz tedavisinde D vitamini, bifosfonatlar, odanacatib, neridronat, teriparatid ve raloksifenin kullanımının tedavi sürecindeki etkinliği araştırılmaktadır. Bu amaçla mevcut araştırmaların harmanlanarak yorumlanmasına olanak sunan meta-analiz yöntemi kullanılmıştır. Çalışmaya 10 birincil çalışma dâhil edilmiştir. Çalışma, osteoporoz ilaçlarının serum phosphate, sCTX ve Serum 25(OH)D değerleri üzerindeki etkisini değerlendirmeyi amaçlamıştır. Bulgularımız, osteoporoz ilaçlarının bu parametreler üzerinde genel bir etkiye sahip olduğunu göstermektedir. Osteoporoz ilaçlarının birleştirilmiş etki büyüklüğü -1,53 (CI: -3,00 ila -0,07) olarak hesaplanmıştır. Serum phosphate, sCTX ve Serum 25(OH)D değerleri için ayrı ayrı yapılan analizlerde de bu ilaçların olumlu etkileri tespit edilmiştir.

Anahtar Kelimeler:

Bifosfonat, D Vitamini, Odanacatib, Osteoporoz tedavisi, Teriparatid

A Meta-analysis on the Efficacy of Various Medicated Treatment Options for Osteoporosis

This meta-analysis aims to review and evaluate different osteoporosis treatment options and examine their efficacy. In particular, the effectiveness of vitamin D, bisphosphonates, odanacatib, neridronate, teriparatide, and raloxifene in the treatment of osteoporosis is investigated. For this purpose, the meta-analysis method, which allows the existing studies to be collated and interpreted, was used. Ten primary studies were included in the study. The study aimed to evaluate the effect of osteoporosis drugs on serum phosphate, sCTX, and serum 25(OH)D values. Our findings show that osteoporosis drugs have an overall effect on these parameters. The pooled effect size of osteoporosis drugs was calculated as-1.53 (CI: -3,00 to -0,07). Separate analyses for serum phosphate, sCTX, and serum 25(OH)D values also showed positive effects of these drugs.

Keywords:

Bisphosphonate, Odanacatib, Osteoporosis treatment, Teriparatide, Vitamin D,

PDF

___

1. Tu, K. N, Lie, J. D, Wan, C. K. V, Cameron, M, Austel, A. G, Nguyen, J. K. and Hyun, D. (2018). “Osteoporosis: a Review of Treatment Options”. Pharmacy and Therapeutics, 43(2), 92-104.
2. Hopkins, R. B, Goeree, R, Pullenayegum, E, Adachi, J. D, Papaioannou, A, Xie, F. and Thabane, L. (2011). “The Relative Efficacy of Nine Osteoporosis Medications for Reducing the Rate of Fractures in Post-Menopausal Women”. BMC Musculoskeletal Disorders, 12, 1-16.
3. Srivastava, A. K, Vliet, E. L, Michael Lewiecki, E, Maricic, M, Abdelmalek, A, Gluck, O. and Baylink, D. J. (2005). “Clinical Use of Serum and Urine Bone Markers in the Management of Osteoporosis”. Current Medical Research and Opinion, 21(7), 1015-1026.
4. Rossini, M, Gatti, D, Viapiana, O, Fracassi, E, Idolazzi, L, Zanoni, S. and Adami, S. (2012). “Short-term Effects on Bone Turnover Markers of a Single High Dose of Oral Vitamin D3”. The Journal of Clinical Endocrinology & Metabolism, 97(4), E622-E626.
5. van der Burgh, A. C, de Keyser, C. E, Zillikens, M. C. and Stricker, B. H. (2021). “The Effects of Osteoporotic and Non-Osteoporotic Medications on Fracture Risk and Bone Mineral Density”. Drugs, 81, 1831–1858. https://doi.org/10.1007/s40265-021-01625-8.
6. Chen, C. H, Lo, W. C, Hu, P. J, Chan, H. C, Shen, W. C, Wu, M. S. and Wu, M. Y. (2022). “Efficacy of Osteoporosis Medications for Patients with Chronic Kidney Disease: an Updated Systematic Review and Network Meta-Analysis”. Frontiers in Pharmacology, 13. https://doi.org/10.3389/fphar.2022.822178
7. Kan, B, Zhao, Q, Wang, L, Xue, S, Cai, H. and Yang, S. (2021). “Association Between Lipid Biomarkers and Osteoporosis: A Cross-Sectional Study. BMC Musculoskeletal Disorders”. 22(1), 759. https://doi.org/10.1186/s12891-021-04643-5
8. Sabri, S. A, Chavarria, J. C, Ackert-Bicknell, C, Swanson, C. and Burger, E. (2023). “Osteoporosis: An Update on Screening, Diagnosis, Evaluation, and Treatment”. Orthopedics, 46(1), e20-e26. https://doi.org/10.3928/01477447-20220719-03
9. Lin, S. Y, Hung, M. C, Chang, S. F, Tsuang, F. Y, Chang, J. Z. C. and Sun, J. S. (2021). “Efficacy and Safety of Postmenopausal Osteoporosis Treatments: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials”. Journal of Clinical Medicine, 10(14), 3043. https://doi.org/10.3390/jcm10143043
10. Kendler, D. L, Cosman, F, Stad, R. K. and Ferrari, S. (2022). “Denosumab in the Treatment of Osteoporosis: 10 Years Later: A Narrative Review”. Advances in Therapy, 39(1), 58-74.
11. Adami, S, Gatti, D, Bertoldo, F, Sartori, L, Di Munno, O, Filipponi, P, Marcocci, C, Frediani, B, Palummeri, E, Fiore, C.E, Costi, D. and Rossini, M. (2008). “Intramuscular Neridronate in Postmenopausal Women with Low Bone Mineral Density”. Intramuscular Neridronate in Postmenopausal Women with Low Bone Mineral Density. Calcif Tissue Int, 83, 301–307. https://doi.org/10.1007/s00223-008-9179-5
12. Anastasilakis, A. D, Goulis, D. G, Mantzoros, C. S, Gerou, S, Koukoulis, G, Kita, M. And Avramidis, A. (2008). “Serum Osteoprotegerin and Rankl are not Specifically Altered in Women with Postmenopausal Osteoporosis Treated with Teriparatide or Risedronate: a Randomized, Controlled Trial”. Hormone and Metabolic Research, 40(4), 281-285. https://doi.org/10.1055/s-2008-1046787
13. Deal, C, Omizo, M, Schwartz, E. N, Eriksen, E. F, Cantor, P, Wang, J, Glass, E. V, Myers, S. L. and Krege, J. H. (2005). “Combination Teriparatide and Raloxifene Therapy for Postmenopausal Osteoporosis: Results from a 6-month Double-Blind Placebo-Controlled Trial”. Journal of Bone and Mineral Research, 20(11), 1905–1911.
14. Matsumoto, T, Hagino, H, Shiraki, M, Fukunaga, M, Nakano, T, Takaoka, K, Morii, H, Ohashi, Y. and Nakamura, T. (2009). “Effect of Daily Oral Minodronate on Vertebral Fractures in Japanese Postmenopausal Women with Established Osteoporosis: a Randomized Placebo-Controlled Double-Blind Study”. Osteoporosis International, 20(8), 1429–1437. https://doi.org/10.1007/s00198-008-0816-7
15. Grimnes, G, Joakimsen, R, Figenschau, Y, Torjesen, P. A, Almås, B. and Jorde, R. (2012). The Effect of High-dose Vitamin D on Bone Mineral Density and Bone Turnover Markers in Postmenopausal Women with Low Bone Mass: A Randomized Controlled 1-Year Trial. Osteoporosis International, 23(1), 201–211. https://doi.org/10.1007/s00198-011-1752-5
16. McClung, M.R, O'Donoghue, M.L, Papapoulos, S.E, Bone, H, Langdahl, B, Saag, K.G, Reid, I.R, Kiel, D.P, Cavallari, I, Bonaca, M.P, Wiviott, S.D, de Villiers, T, Ling, X, Lippuner, K, Nakamura T, Reginster JY, Rodriguez-Portales JA, Roux C, Zanchetta, J, Zerbini, C.A.F, Park, J.G, Im, K, Cange, A, Grip, L.T, Heyden, N, DaSilva, C, Cohn, D, Massaad, R, Scott, B.B, Verbruggen, N, Gurner, D, Miller, D.L, Blair, M.L, Polis, A.B, Stoch, S.A, Santora, A, Lombardi, A, Leung, A.T, Kaufman, K.D. and Sabatine (2019). “Odanacatib for the Treatment of Postmenopausal Osteoporosis: Results of the LOFT Multicentre, Randomised, Double-Blind, Placebo-Controlled Trial and LOFT Extension Study”. Lancet Diabetes Endocrinol, 7(12), 899–911. https://doi.org/10.1016/S2213-8587(19)30346-8
17. Binkley, N, Ringe, J. D, Reed, J. I, Ljunggren, O, Holick, M. F, Minne, H. W, Liu, M, Lamotta, A, West, J. A. and Santora, A. C. (2009). “Alendronate/vitamin D3 70 mg/2800 IU with and without Additional 2800 IU Vitamin D3 for Osteoporosis: Results from the 24-Week Extension of a 15-Week Randomized, Controlled Trial”. Bone, 44(4), 639–647. https://doi.org/10.1016/j.bone.2008.05.002
18. Kumagai, Y, Ose, A, Tanaka, K. and Sugimoto, T. (2020). “Safety Profiles, Pharmacokinetics, and Changes in Bone Turnover Markers After Twice-Weekly Subcutaneous Administration of Teriparatide in Healthy Japanese Postmenopausal Women: A Single-Blind Randomized Study”. Clinical Pharmacology in Drug Development, 9(1), 87–96. https://doi.org/10.1002/cpdd.687
19. Karimi Fard, M, Aminorroaya, A, Kachuei, A, Salamat, M. R, Hadi Alijanvand, M, Aminorroaya Yamini, S, Karimifar, M, Feizi, A. and Amini, M. (2019). “Alendronate Improves Fasting Plasma Glucose and Insulin Sensitivity, and Decreases Insulin Resistance in Prediabetic Osteopenic Postmenopausal Women: A Randomized Triple-Blind Clinical Trial”. Journal of Diabetes Investigation, 10(3), 731–737. https://doi.org/10.1111/jdi.12944
20. Rossini, M, Gatti, D, Girardello, S, Braga, V, James, G. and Adami, S. (2000). “Effects of Two İntermittent Alendronate Regimens in the Prevention or Treatment of Postmenopausal Osteoporosis”. Bone, 27(1), 119–122. https://doi.org/10.1016/s8756-3282(00)00291-x
21. Duval, S. and Tweedie, R. (2000). “Trim and Fill: a Simple Funnel‐Plot–Based Method of Testing and Adjusting for Publication Bias in Meta‐Analysis”. Biometrics, 56(2), 455-463.
22. Begg, C. B. and Mazumdar, M. (1994). “Operating Characteristics of a Rank Correlation Test for Publication Bias”. Biometrics, 50(4), 1088-1101. https://doi.org/10.2307/2533446
23. Egger, M, Smith, G. D, Schneider, M. and Minder, C. (1997). “Bias in Meta-Analysis Detected by a Simple, Graphical Test”. Bmj, 315(7109), 629-634.
24. Rosenthal, R. and Rubin, D. B. (1979). “A Note on Percent Variance Explained as a Measure of the Importance of Effects”. Journal of Applied Social Psychology, 9(5), 395–396. https://doi.org/10.1111/j.1559-1816.1979.tb02713.x
25. Fisher, R. A. (1932). “Statistical Methods for Research Workers”. England/London: Oliver and Boyd.