目的 評價阿侖膦酸鹽預防和治療男性骨質(zhì)疏松癥的效果和可能的不良反應。
方法 電子檢索：MEDLINE（1990～2005）、EMBASE（1990～2005）、Cochrane圖書館臨床對照試驗資料庫（2005年第3 期）、Current Controlled Trials、The National Research Register、中國生物醫(yī)學文獻數(shù)據(jù)庫（1990～2005）和中文科技期刊全文數(shù)據(jù)庫（1990～2005）、中文學術(shù)期刊全文數(shù)據(jù)庫（1990～2005），并手工檢索相關(guān)領(lǐng)域其他雜志。檢索時間截止至2005年11月。所有檢索均不受語種限制。納入以有骨質(zhì)疏松癥高危風險或患骨質(zhì)疏松癥男性為研究對象、比較阿侖膦酸鹽與其它療法療效的隨機對照試驗，評價納入研究的質(zhì)量，并用RevMan 4.28軟件進行Meta分析。
結(jié)果 共納入7個隨機對照試驗，包括817例患者。Meta分析結(jié)果顯示，阿侖膦酸鹽+鈣劑對提高骨質(zhì)疏松癥高危男性患者腰椎骨密度的作用優(yōu)于單用鈣劑[SMD 0.59，95%CI（0.15，1.03），P=0.009]；對于降低骨折風險，阿侖膦酸鹽+鈣劑與單用鈣劑相似；對于降低脊柱骨折的風險，2年以上療程的阿侖膦酸鹽治療優(yōu)于α-骨化醇，但是對于非脊椎骨折，兩者療效相似；阿侖膦酸鹽提高骨密度的效果優(yōu)于α-骨化醇、鈣劑；在預防骨質(zhì)疏松癥、提高骨密度方面，阿侖膦酸鹽不如降鈣素、α-骨化醇、甲狀旁腺激素；阿侖膦酸鹽聯(lián)合甲狀旁腺激素優(yōu)于單獨使用阿侖膦酸鹽；阿侖膦酸鹽聯(lián)合甲狀旁腺激素與單獨使用甲狀旁腺激素比較，兩者對提高骨密度的療效相似。
結(jié)論 阿侖膦酸鹽預防和治療男性骨質(zhì)疏松癥的療效優(yōu)于鈣劑；對于提高骨密度，阿侖膦酸鹽不如降鈣素、α-骨化醇；長期使用阿侖膦酸鹽比α-骨化醇更能減少脊柱骨折的風險。阿侖膦酸鹽聯(lián)合甲狀旁腺激素與單用甲狀旁腺激素比較，兩者在治療男性骨質(zhì)疏松癥方面的效果相似。今后尚需開展更多高質(zhì)量特別是多中心研究以增加證據(jù)的強度。
引用本文： 朱汝霞,歐陽玲莉,吳泰相. 阿侖膦酸鹽預防和治療男性骨質(zhì)疏松癥療效的系統(tǒng)評價. 中國循證醫(yī)學雜志, 2006, 06(3): 195-201. doi: 復制
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| 11. | Ringe JD, Dorst A, Faber H, et al. Alendronate treatment of established primary osteoporosis in men: 3-year results of a prospective, comparative, two-arm study. Rheumatol Int, 2004; 24(2):110-113. |
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- 1. 傅明捷, 黃萍, 王敏健, 等. 阿侖膦酸鈉對老年男性骨質(zhì)疏松癥骨密度的影響. 實用老年醫(yī)學, 2002; 16(1): 36-37.
- 2. Consensus development conference: prophylaxis and treatment of osteoporosis. Am J Med, 1991; 90(1): 107-110.
- 3. Seeman E. Advances in the study of osteoporosis in men. In Meunier PJ, ed. Osteoporosis, Diagnosis and Management. London: Martin Dunitz, 1998; 221-232.
- 4. Campion JM, Maricic MJ. Osteoporosis in men. Am Fam Physician, 2003; 67(7): 1521-1526.
- 5. Juni P, Altman DG, Egger M. Systematic reviews in health care: Assessing the quality of controlled clinical trials. BMJ, 2001; 323(7303): 42-46.
- 6. El-Agroudy AE, El-Husseini AA, El-Sayed M, et al. A prospective randomized study for prevention of postrenal transplantation bone loss. Kidney Int, 2005; 67(5):2039-2045.
- 7. Finkelstein JS, Hayes A, Hunzelman JL, et al. The effects of parathyroid hormone, alendronate, or both in men with osteoporosis. N Engl J Med, 2003; 349(13): 1216-1226.
- 8. Fu MJ, Huang P, Wang MJ, et al. The effect of alendronate on the bone mineral density of men with senile osteoporosis. Practical Geriatrics, 2002; 16(1): 36-37.
- 9. Orwoll E, Ettinger M, Weiss S, et al. Alendronate for the treatment of osteoporosis in men. N Engl J Med, 2000; 343(9): 604-610.
- 10. Ringe JD, Faber H, Dorst A. Alendronate treatment of established primary osteoporosis in men: results of a 2-year prospective study. J Clin Endocrinol Metab, 2001; 86(11): 5252-5255.
- 11. Ringe JD, Dorst A, Faber H, et al. Alendronate treatment of established primary osteoporosis in men: 3-year results of a prospective, comparative, two-arm study. Rheumatol Int, 2004; 24(2):110-113.
- 12. Zehnder Y, Risi S, Michel D, et al. Prevention of bone loss in paraplegics over 2 years with alendronate. J Bone Miner Res, 2004; 19(7):1067-1074.