Alendronate For The Treatment Of Men With Osteopenia Or Osteoporosis: A Systematic Review

Objective Alendronate(ALN)are widely prescribed for men osteoporosis(OP). Yet there is a paucity of such randomized controlled trials(RCT)in osteoporotic men,to this day there still lack of comparative and evaluate scientifically.Our objective was to systematically review the efficacy and adverse events of ALN on bone mineral density(BMD)and fractures in men with osteopenia or OP, proved the best available choice for patients,offer the best evidence for clinical decision making.Methods We electronically searched MEDLINE(1990-2006),EMBASE (1990-2006),The Controlled Trials Register and The National Research Register of The Cochrane Library(Issue 4,2006),CBM disc,VIP,and CNKI.We also handsearched some related journals.The search was conducted in Nov.2006. The quality of included RCT was evaluated and Meta analysis was conducted by RevMan 4.2.8.Results We identified 7 studies including 817 patients.Meta analysis showed to reduce the risk of fractures,the combination of ALN and calcium compared to calcium didn't show statistical difference;ALN was superior to calcium in increasing the BMD of the lumbar spine at lyear and 2 year[SMD 0.48,95%CI(0.19,0.78);SMD 0.94,95%CI(0.01,1.87)];to increase the BMD of the femoral neck at lyear,the combination of ALN and calcium didn't showed significant difference to the calcium[SMD 0.78,95%CI(-0.60,2.16)]. The incidence of withdrawal and lost to follow-up due to adverse events of the ALN was lower than that of calcium[RR 0.32,95%CI(0.11,0.87)].In one study the men with osteopenia,the compare of ALN to calcitonin or alfacalcidol(AC)had no significantly statistical difference.Two studies showed at 2 years or at 3 years,ALN was superior to AC in increasing the BMD and reducing the vertebral fractures but no with the non-vertebral fractures in men with OP.One study comparing ALN or parathyroid hormone with combination of these drugs in men with OP suggested that ALN wasn't superior to parathyroid hormone in increasing the BMD,and the combination did not show significant difference compared to parathyroid hormone alone.Conclusions ALN is more effective in treating the men with osteopenia or OP compared to calcium.ALN isn't more effective than calcitonin or AC in increasing BMD in men with osteopenia.In men with OP,ALN is superior to AC with increasing the BMD and reducing the risk of the lumbar spine.ALN compared to combination of parathyroid hormone does not show more effectiveness in increasing the bone mineral density in men with OP.More RCT of high quality,especially multiple center trials are needed to generate stronger evidence.