双膦酸盐预防中国妇女绝经后骨质疏松骨折的系统评价及药物经济学分析

发布时间：2018-04-14 12:24

本文选题：双膦酸盐 + 绝经期妇女骨质疏松　；参考：《中国医院药学杂志》2017年08期

【摘要】：目的:评估3种双膦酸盐预防中国妇女绝经后骨质疏松骨折的有效性、安全性和经济性。方法:计算机检索国内外常用文献数据库中使用阿仑膦酸、利塞膦酸、唑来膦酸预防中国妇女绝经后骨质疏松骨折的随机对照试验(RCT),提取资料后进行Meta分析,并建立决策树模型进行成本-效果分析。结果:Meta分析结果显示,与单用钙剂/维生素D_3方案相比,联用双膦酸盐能显著减少中国妇女绝经后骨质疏松的椎体骨折[RR0.50,95%CI(0.33,0.74)]和非椎体骨折[RR0.36,95%CI(0.20,0.65)]的风险,差异有统计学意义(P0.01)。亚组分析显示,唑来膦酸能显著减少中国妇女绝经后骨质疏松椎体骨折[RR0.44,95%CI(0.25,0.77)]风险,阿仑膦酸和利塞膦酸亦表现出减少绝经后骨质疏松非椎体骨折的风险的优势[RR0.16,95%CI(0.04,0.72)和RR0.28,95%CI(0.10,0.80)]。安全性方面,加用双膦酸盐期间不良事件的发生率与对照组比较差异无统计学意义。成本-效果分析显示,联用双膦酸盐较单用钙剂和维生素D_3方案经济性更优,阿仑膦酸联合钙剂/维生素D3方案为经济性最优方案。结论:联用双膦酸盐(尤其是阿仑膦酸)较单用钙剂/维生素D_3方案能显著地减少中国妇女绝经后骨质疏松骨折的风险,安全性较好,经济性更优。
[Abstract]:Objective: to evaluate the efficacy, safety and economy of three bisphosphonates in the prevention of postmenopausal osteoporosis in Chinese women.Methods: a randomized controlled trial of alendronic acid, Lise phosphonic acid and zoledronic acid to prevent postmenopausal osteoporosis fracture in Chinese women was searched by computer. The data were extracted and analyzed by Meta.A decision tree model is established for cost-effect analysis.Results compared with calcium / vitamin D3 regimen alone, the combined use of bisphosphonates significantly reduced the risk of postmenopausal osteoporosis vertebral fracture [RR0.50C95CI0.33 / 0.74] and non-vertebral fracture (RR0.3695CI0.200.65). The difference was statistically significant (P 0.01).Subgroup analysis showed that zoledronic acid significantly reduced the risk of postmenopausal osteoporotic vertebral fracture in Chinese women [RR0.44-95CI0.250.77]. Alendronic acid and Lise phosphonic acid also showed an advantage in reducing the risk of nonvertebral fracture in postmenopausal osteoporosis (RR0.1695CI0.040.72) and RR0.2895CII 0.10 / 0.80].In terms of safety, the incidence of adverse events during the addition of bisphosphonates was not significantly different from that in the control group.Cost-effect analysis showed that the combined use of bisphosphonates was more economical than that of calcium and vitamin D3 alone, and alendronic acid combined with calcium / vitamin D3 was the best.Conclusion: the combination of bisphosphonates (especially alendronic acid) can significantly reduce the risk of postmenopausal osteoporosis fracture in Chinese women compared with calcium / vitamin D _ 3 alone. It is safe and economical.
【作者单位】：西安交通大学医院;西安市红会医院;西安市第五医院;
【基金】：陕西省自然科学基础研究计划(编号:2015JM8422) 中央高校基本科研业务费专项资金资助
【分类号】：R580;R683

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