A Meta-analysis Of Zoledronic Acid For The Treatment Of Postmenopausal Osteoporosis

Objective:Postmenopausal osteoporosis(PMOP)is a common type of osteo-porosis.The prevalence rate of PMOP is gradually increasing with the extension of life expectancy.PMOP and various of fragility fractures have brought heavy burden to society,family and individuals.As a common and frequently occurring disease,the prevention and treatments of PMOP are particularly important.Zoledronic acid,as the third generation bisphosphonate,has greatly improved the efficacy compared with the first two generations of bisphosphonates.Although there are a large number of randomized controlled studies to study the clinical effects and adverse events of intravenous zoledronic acid 5mg/year therapy versus placebo in the treatment of PMOP,few comprehensive analysis is published to summarize the results of these studies.Using the basic theories and methods of evidence-based medicine,this meta-analysis tries to screen out all the relevant studies as much as possible,and evaluates the quality of every study.By using data analysis software,the results of this meta-analysis provides evidence of efficacy and adverse events for clinical application of zoledronic acid.Materials and Methods:We searched related researches with Chinese and English key words in the authoritative databases and then selected researches according to the meta-analysis standards of the inclusion and exclusion criteria.Researches'characteristics were extracted and researches' qualities were evaluated after the process mentioned above.The outcomes mainly included effectiveness indicators and safety indicators.The indicators of effectiveness included incidence of spinal and hip fractures,changes of bone mineral density before and after treatment,and changes of bone metabolic markers before and after treatment.The safety indicators included severe complications/death and five most common flu like reactions.Revman 5.1 software was used to integrate data to come into forest plots to analyze outcomes.Results:Zoledronic acid was compared with placebo.The risk of spinal fracture was significantly reduced by OR = 0.29,95%CI[0.24,0.35],and the risk of hip fracture was significantly reduced by OR = 0.61,95%CI[0.48,0.77],and bone mineral density increased significantly by WMD = 5.79,95%CI[5.01,6.57],the hip bone density increased significantly by WMD?4.30,95%CI ?[3.83,4.78].The bone metabolic were obviously reduced,and the high metabolism of bone was inhibited by zoledronic acid.The WMD of ?-CTX was-43.9,95%CI[-49.83,-37.98],and the WMD was-36.17,95%CI[-37.34,-35.00]in t-PINP.There was no significant differences in severe complications/deaths with OR = 0.96,95%CI[0.89,1.04],and the incidents of five common adverse reactions(fever,headache,muscle pain,joint pain,fatigue)in the zoledronic acid group and placebo group were different with OR= 9.94,95%CI[4.64,21.31].Conclusions:5mg/year intravenous zoledronic acid compared with placebo significantly reduces the risk of hip and spinal fractures,increases bone mineral density in the hip and spine,reduces bone metabolic markers,and has a considerable safety.It does not increase the rate of severe adverse events and mortality.Therefore,zoledronic acid is proved to be a good choice for treating PMOP.