-
Journal of Clinical Pharmacology Apr 2023This systematic review and meta-analysis aimed to reveal the efficacy and safety of zoledronic acid compared with alendronate in patients with primary osteoporosis. The... (Meta-Analysis)
Meta-Analysis
This systematic review and meta-analysis aimed to reveal the efficacy and safety of zoledronic acid compared with alendronate in patients with primary osteoporosis. The PubMed, Embase, and the Cochrane Library databases were searched from the establishment of each database to April 2022 for comparative studies on the topic, including randomized controlled trials (RCTs) and cohort studies, and 2 authors individually extracted information and data concerning study design, baseline characteristics, bone mineral density (BMD), bone turnover markers, and adverse events (AEs). We identified 8 eligible trials, including 1863 participants. Pooled estimates demonstrated that, compared with alendronate, zoledronic acid showed no significant difference in increasing the BMD of the lumbar spine after 1 year (SMD = -0.03, 95%CI -0.15 to 0.09, I = 0.41%) or after 2 years (SMD = 0.16, 95%CI -0.12 to 0.43, I = 63%), and the BMD of the total hip after 1 year (SMD = -0.08, 95%CI -0.31 to 0.14, I = 64%) or after 2 years (SMD = 0.05, 95%CI -0.21 to 0.32, I = 61%). No significant difference in improving bone turnover markers, including serum C-terminal cross-linking telopeptide of type-1 collagen, urine N-terminal cross-linking telopeptide of type-1 collagen, and serum procollagen type-1 N-terminal propeptide, were found, whereas significantly higher total AE rates (RR = 2.27, 95%CI 1.60 to 3.21, I = 75%) were recorded within 3 days of infusion, but some lower AE rates, particularly of gastrointestinal AEs (RR = 0.6, 95%CI 0.44 to 0.83, I = 37%), were noted after 3 days of infusion. Compared with alendronate, zoledronic acid has achieved comparable therapeutic results in the treatment of primary osteoporosis in increasing BMD and reducing bone turnover marker levels. Zoledronic acid showed a better safety profile than alendronate with long-term use, especially with regards to gastrointestinal-related AEs.
Topics: Humans; Female; Alendronate; Zoledronic Acid; Diphosphonates; Bone Density Conservation Agents; Bone Density; Osteoporosis; Osteoporosis, Postmenopausal
PubMed: 36433675
DOI: 10.1002/jcph.2181 -
World Neurosurgery Feb 2023Bone loss is not to be underestimated in people with acute spinal cord injury (SCI). Bisphosphonates can inhibit the bone resorption of osteoclast. To study whether the... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Bone loss is not to be underestimated in people with acute spinal cord injury (SCI). Bisphosphonates can inhibit the bone resorption of osteoclast. To study whether the early application of bisphosphonates can alleviate bone loss after acute SCI, we included 7 randomized controlled trials for meta-analysis.
METHODS
Seven randomized controlled trials were found in literature databases. The percentage change in bone mineral density (BMD) at different sites were primary outcomes and serum bone turnover markers were secondary outcomes. A random-effects model was selected for meta-analysis.
RESULTS
There were significant differences in the percentage change in BMD of the lumbar spine, total hip, and femoral neck between the bisphosphonates and control groups, but not in the percentage change in distal femur BMD. Besides, there were no statistically significant differences between the groups in the bone formation marker Procollagen type 1 N propeptide; bisphosphonates were effective in reducing the C-terminal telopeptide at the 6-month follow-up, but not at the 12-month follow-up. Subgroup analysis of the effects of zoledronate showed positive effects on BMD of the lumbar spine, total hip, and femoral neck at the 6-month follow-up and showed positive effects on BMD of the total hip and femoral neck at the 12-month follow-up.
CONCLUSIONS
Bisphosphonates can effectively alleviate the bone loss of the lumbar spine, total hip, and femoral neck in patients with acute SCI, and early application is advocated.
Topics: Humans; Diphosphonates; Bone Density Conservation Agents; Bone Diseases, Metabolic; Bone Density; Spinal Cord Injuries; Biomarkers
PubMed: 36410707
DOI: 10.1016/j.wneu.2022.11.069 -
World Neurosurgery Feb 2023Ehlers-Danlos type IV or vascular Ehlers-Danlos syndrome (vEDS) is a rare inherited disorder characterized by profound vascular fragility resulting from defective...
BACKGROUND
Ehlers-Danlos type IV or vascular Ehlers-Danlos syndrome (vEDS) is a rare inherited disorder characterized by profound vascular fragility resulting from defective production of type III procollagen. Cerebrovascular diseases including spontaneous dissections, cerebral aneurysms, and cavernous carotid fistulae are common. Endovascular therapies in this patient population are known to be higher risk, although many studies (before 2000) involved older techniques and equipment. The purpose of this study is to investigate the safety and efficacy of modern neuroendovascular techniques in the treatment of cerebrovascular diseases in patients with vEDS.
METHODS
We combined a multi-institutional retrospective case series at 3 quaternary-care centers with a systematic literature review of individual case reports and case series spanning 2000-2021 to evaluate the safety and efficacy of neuroendovascular procedure in patients with vEDS with cerebrovascular diseases.
RESULTS
Fifty-nine patients who underwent 66 neuroendovascular procedures were evaluated. Most of the patients had direct cavernous carotid fistulas (DCCF). Neuroendovascular procedures had a 94% success rate, with a complication rate of 30% and a mortality of 7.5%.
CONCLUSIONS
Neuroendovascular procedures can be performed with a high rate of success in the treatment of cerebrovascular diseases in patients with vEDS, although special care is required because complication rates and mortality are high. Access site and procedure-related vascular injuries remain a significant hurdle in treating vEDS with cerebrovascular diseases, even with modern techniques.
Topics: Humans; Retrospective Studies; Ehlers-Danlos Syndrome; Cavernous Sinus; Ehlers-Danlos Syndrome, Type IV; Intracranial Aneurysm; Multicenter Studies as Topic
PubMed: 36402305
DOI: 10.1016/j.wneu.2022.11.067 -
Medicine Nov 2022Meta-analysis was used to evaluate the efficacy of Fufang Biejia Ruangan Tablets in the treatment of chronic hepatitis B (CHB) liver fibrosis. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Meta-analysis was used to evaluate the efficacy of Fufang Biejia Ruangan Tablets in the treatment of chronic hepatitis B (CHB) liver fibrosis.
METHODS
Databases, including PubMed, China Knowledge Network (CNKI), China Biomedical Database (CBM), Wan Fang, VIP database, Embase, and Cochrane Library were searched. The time was searched up to May 2022. The participant intervention comparator outcomes of this study were as follows: P, patients with CHB liver fibrosis; I, Fufang Biejia Ruangan Tablets; C, pharmacological placebo; O, the efficacy rate, alanine transaminase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), albumin (ALB), procollagen III protein (PIIIP), hyaluronic acid (HA), laminin (LN), collagen C type IV (IV-C), portal vein diameter, spleen thickness and HBV-DNA negative conversion rate. The Cochrane Risk of Bias tool, Begg's test and Egger's test were used to evaluate the methodological quality of eligible studies. A randomized controlled trial of Fufang Biejia Ruangan Tablets was used to treat CHB liver fibrosis. Three reviewers independently selected trials, extracted data, cross-checked, and performed methodological quality assessments. Data analysis was completed by Review Manager 5.3.
RESULTS
Twenty-six studies with 2717 patients were included in the meta-analysis. The meta-analysis showed that Fufang Biejia Ruangan Tablets was effective by increasing the efficacy. Fufang Biejia Ruangan Tablets was more efficient in improving ALT, AST, TBIL, ALB, PIIIP, HA, LN, IV-C, portal vein diameter, spleen thickness, and HBV-DNA negative conversion rate with no serious adverse reactions.
CONCLUSION
It was shown that Fufang Biejia Ruangan Tablets can effectively improve liver function and relieve liver fibrosis, but future research should focus on rigorously designed, multicenter, and large randomized controlled trials.
Topics: Humans; Hepatitis B, Chronic; DNA, Viral; Liver Cirrhosis; Alanine Transaminase; Tablets; Adjuvants, Pharmaceutic; Randomized Controlled Trials as Topic; Multicenter Studies as Topic
PubMed: 36401442
DOI: 10.1097/MD.0000000000031664 -
Annals of Palliative Medicine Oct 2022Postmenopausal women are one of the most vulnerable groups to osteoporosis. Romosozumab is a newly monoclonal drug that inhibits the activity of sclerostin. Since it has... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Postmenopausal women are one of the most vulnerable groups to osteoporosis. Romosozumab is a newly monoclonal drug that inhibits the activity of sclerostin. Since it has been on the market for only 3 years, there is a lack of systematic analysis on postmenopausal women and the efficacy is not clear. In this study, we compared randomized controlled trials to assess the effects of blosozumab versus placebo in perimenopausal and postmenopausal women.
METHODS
This meta-analysis has been registered in the PROSPERO registry (number CRD42020145839). The PubMed, Cochrane Library, ClinicalKey, and Embase databases were searched from inception date to July 01, 2021. We used the keywords "osteoporosis", "decreased bone mass", and "blosozumab" to retrieve studies on the relationship between blosozumab and osteoporosis in each database. The inclusion criteria were: (I) randomized controlled trials (RCTs) comparing the treatment of osteoporosis with blosozumab and a placebo or without treatment, (II) studies on postmenopausal women aged over 50 years, and (III) studies providing bone mineral density data. The quality of all randomized controlled trials included in this study was independently assessed by two researchers according to the Cochrane risk manual and was divided into high, medium and low quality. The main results analyzed were bone mineral density (BMD) and T-score. Our results mainly include BMD and procollagen type I N-terminal propeptide (P1NP), C-terminal telopeptide of type I collagen (CTX), bone-specific alkaline phosphatase (BSAP), and osteocalcin (OC).
RESULTS
Three RCTs with 105 patients were selected from 157 retrieved articles. Due to high heterogeneity [BMD: Tau2=2.79; Chi2=11.70, degrees of freedom (df) =1 (P=0.0006); I2=91%], we could not perform statistical analysis of BMD. The results of BMD were then evaluated systematically. Three RCT studies were included in the evaluation. Compared with that of the placebo, blosozumab increased levels of the BMD biomarker osteocalcin [mean deviation (MD) 12.55; 95% confidence interval (CI), 8.18, 16.91; P<0.00001]. None of the 3 RCTs presented a risk of bias during the meta-analysis.
CONCLUSIONS
The results suggested that blosozumab could be used as a target drug to improve BMD in postmenopausal women. This will provide a reference for the clinical treatment of postmenopausal women with osteoporosis.
Topics: Female; Humans; Middle Aged; Bone Density Conservation Agents; Osteocalcin; Osteoporosis; Osteoporosis, Postmenopausal; Postmenopause; Randomized Controlled Trials as Topic
PubMed: 36367007
DOI: 10.21037/apm-22-998 -
Frontiers in Medicine 2022Hepatic fibrosis is a health challenge due to the absence of satisfactory therapy, especially at the cirrhosis stage. Dahuang Zhechong pill (DHZCP)-based therapy is...
BACKGROUND
Hepatic fibrosis is a health challenge due to the absence of satisfactory therapy, especially at the cirrhosis stage. Dahuang Zhechong pill (DHZCP)-based therapy is reportedly a successful treatment for hepatic fibrosis and is even beneficial for the treatment of cirrhosis. Hence, a systematic review and clinical evidence assessment of DHZCP-based therapy should be performed, and clinical recommendations based on its efficacy for the treatment of hepatic fibrosis should be generated. With respect to potential indicators, the comparative value of the hepatic function, spleen thickness, and portal vein internal diameter should be evaluated.
MATERIALS AND METHODS
PubMed, the Excerpta Medica Database, the Cochrane Library, the Web of Science, the WanFang Database, the Chinese Scientific Journal Database, and the Chinese National Knowledge Infrastructure database were searched to identify clinical trials. Three subgroup analyses were performed based on the stage of disease, medication use, and the course of treatment. Statistical analyses were performed using Review Manager 5.4.
RESULTS
A total of 18 studies including 1,494 patients were evaluated. The DHZCP-based therapy was effective in reducing the plasma levels of hyaluronic acid, and laminin, procollagen III, and IV collagen were also reduced irrespective of the hepatitis stage or the presence of hepatic cirrhosis. Abnormalities in alanine aminotransferase, aspartate aminotransferase, albumin, and total bilirubin were reversed. A 6-month course of treatment was the most beneficial DHZCP-based therapy regimen. Alanine aminotransferase improvement was more obvious in patients with cirrhosis, and alanine aminotransferase was reduced significantly in patients with hepatic cirrhosis. With respect to pharmacological mechanisms, DHZCP-based therapy could inhibit hepatic stellate cell growth and activation, reduce inflammation, and prevent extracellular matrix formation. Hepatic portal hypertension and splenomegaly were ameliorated significantly in the DHZCP-based therapy group.
CONCLUSION
Dahuang Zhechong pill-based therapy has demonstrated efficacy as a treatment for hepatic fibrosis and cirrhosis. A 6-month course of treatment is the recommended option for DHZCP-based therapy in clinical practice. The combination of DHZCP-based therapy and entecavir is a favorable treatment for hepatic cirrhosis.
PubMed: 36314011
DOI: 10.3389/fmed.2022.920062 -
Sports Medicine (Auckland, N.Z.) Dec 2022Recreational football is an intense, versatile form of exercise with multiple high- and odd-impact actions. Recreational football is therefore hypothesized to be... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Recreational football is an intense, versatile form of exercise with multiple high- and odd-impact actions. Recreational football is therefore hypothesized to be suitable for bone modeling and bone health.
OBJECTIVE
The aim of the present systematic review and meta-analysis was to evaluate the effects of recreational football on bone mineral density (BMD), bone mineral content (BMC) and bone turnover markers (BTM).
DESIGN
Systematic review and meta-analysis.
DATA SOURCES
MEDLINE, PubMed, SPORTDiscus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Google Scholar were searched prior to September 2021. A manual database search was also performed using the following key terms, either singly or in combination: recreational football/soccer, street football/soccer, recreational small-sided games, effect, influence, impact, bone turnover markers, bone mineral density, bone turnover marker, bone health, osteogenesis, CTX, osteocalcin, P1NP.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES
Randomised and matched controlled trials with participants allocated to a recreational football group or any other type of training intervention or passive control group were included. The primary outcome measures were total BMD, lower limb BMD, total BMC, lower limb BMC, osteocalcin, procollagen type 1N-terminal propeptide (P1NP) and collagen type 1 cross-linked C-telopeptide (CTX). A total of 17 papers met the inclusion criteria and were included.
STATISTICAL ANALYSIS
Comprehensive Meta-analysis V.2 software (Biostat, Englewood, New Jersey, USA) was used for the meta-analyses.
RISK OF BIAS
Agreement between the two reviewers was assessed using RoB2 tool and k statistics for full-text screening and rating of relevance and risk of bias. The k agreement rate between reviewers was k = 0.92.
RESULTS
The football interventions included were based on studies having a duration of 12-64 weeks with one 5-year follow-up study and with a training frequency of 1-3 sessions/wk. Training sessions were 45-60 min sessions of 3v3 - 7v7 small-sided games. The subjects covered an age span from 9 to 73 years. Five studies examined recreational football effects in females, nine studies in males and three studies included both sexes. Recreational football training produced a statistically significant effect (mean difference = 0.02 g/cm, 95% confidence interval: 0.00-0.03, P = 0.02) on lower limb BMD and negligible effects for total BMD compared to no-exercise controls. The recreational football effects on total and lower limb BMC, when compared to both no-exercise controls and exercise controls, were negligible. A moderate to large significant increase in osteocalcin, P1NP and CTX was observed for recreational football compared to both no-exercise controls and exercise controls.
CONCLUSION
In conclusion, recreational football training regimes lasting 12-64 weeks have a large osteogenic impact on bone turnover markers in comparison with no-exercise controls as well as exercise controls, and beneficial effects on lower limb BMD compared to no-exercise controls. Short and medium duration recreational football interventions have negligible effects on whole-body BMD and BMC (total and lower limb), with magnitudes similar to those of other exercise modes.
Topics: Adolescent; Adult; Aged; Child; Female; Humans; Male; Middle Aged; Young Adult; Bone Density; Follow-Up Studies; Osteocalcin; Soccer
PubMed: 35852769
DOI: 10.1007/s40279-022-01726-8 -
Frontiers in Pharmacology 2022To review the effects of bisphosphonates on bone density, fractures, and bone markers in osteopenic older women. Relevant articles published before February 2022 were...
To review the effects of bisphosphonates on bone density, fractures, and bone markers in osteopenic older women. Relevant articles published before February 2022 were searched in PubMed, EMBASE, and the Cochrane Library. All randomized controlled trials that reported incident fractures, bone mineral density (BMD), bone markers, or adverse events with bisphosphonates in osteopenic older women were included. The quality of included studies was assessed using the Cochrane Risk of Bias tool. The risk ratios (RRs) for fractures, net percent change in bone mineral density and differences in bone markers were calculated using a meta-analysis. A total of 11 studies were included in our meta-analysis. Bisphosphonates significantly increased the percent changes in the lumbar spine BMD (WMD, 5.60; 95% CI, 4.16-7.03; = 93.6%), hip BMD (WMD, 4.80; 95% CI, 2.93 to 6.66; = 97.1%), total body BMD (WMD, 3.24; 95% CI, 2.12-4.35; = 90.9%), femoral neck BMD (WMD, 4.02; 95% CI, 1.70-6.35; = 91.8%) and trochanter BMD (WMD, 5.22; 95% CI, 3.51-6.93; = 83.6%) when compared to placebo. Zoledronate was associated with a great treatment effect on fragility fracture (RR, 0.63; 95% CI, 0.50-0.79), clinical vertebral fracture (RR, 0.41; 95% CI, 0.22-0.76), and radiographic vertebral fracture (RR, 0.60; 95% CI, 0.27-1.35) compared to placebo. Meanwhile, alendronate was also associated with beneficial effects on fragility fracture (RR, 0.40; 95% CI, 0.15-1.07), clinical vertebral fracture (RR, 0.46; 95% CI, 0.17-1.24), and radiographic vertebral fracture (RR, 0.64; 95% CI, 0.38-1.09). In addition, the use of bisphosphonates reduced the concentration of procollagen type I N-terminal propeptide (PINP) and C-terminal telopeptide of type I collagen (CTX) over placebo by 15.79 (95% CI, -18.92 to -12.66; = 28.4%), -0.23 (95% CI, -0.35 to -0.10; = 91.3%), respectively. Although there was insufficient evidence to determine their safety, these bisphosphonates may have an effect on cancer, cardiac events, and mortality in osteopenic older women. All bisphosphonates examined were associated with beneficial effects on fractures, BMD, and bone markers in women with osteopenia. Further randomized controlled trials are necessary to clarify the safety of bisphosphonates in women with osteopenia.
PubMed: 35662708
DOI: 10.3389/fphar.2022.892091 -
Calcified Tissue International Feb 2023There exists a marked circadian variation for several bone markers (BM), which is influenced by endogenous as well as exogenous factors including hormones, physical... (Review)
Review
There exists a marked circadian variation for several bone markers (BM), which is influenced by endogenous as well as exogenous factors including hormones, physical activity, and fasting. Consequently, was the aim of this review to provide an overview of the knowledge of the circadian variation of BM and which factors influence this rhythmicity. A systematic search of PubMed was performed for studies evaluating the circadian variation of BM and which factors influence this rhythmicity. The studies were screened for eligibility by a set of predetermined criteria including a list of relevant BM and a minimum study duration of 24 h with at least 3 blood samples of which two should be at least 6 h apart. In total were 29 papers included. There exists a marked circadian variation for most BM including Carboxy-terminal Cross-Linked Telopeptide of Type I Collagen (CTX) and osteocalcin (OC) with nighttime or early morning peak. Pro-collagen Type I N-terminal Propeptide (PINP) and PTH also showed circadian rhythm but with less amplitude. The inter-osteoblast-osteoclast regulatory markers such as OPG, RANKL, FGF23, and sclerostin showed no circadian rhythm. The markers were differently affected by exogenous factors like fasting, which greatly reduced the circadian variation of CTX but did not affect PINP or OC. The marked circadian variation and the factors which influence the rhythmicity, e.g., fasting are of great consequence when measuring BM. To reduce variation and heighten validity should circadian variation and fasting be kept in mind when measuring BM.
Topics: Circadian Rhythm; Bone and Bones; Collagen Type I; Biomarkers; Osteocalcin
PubMed: 35305134
DOI: 10.1007/s00223-022-00965-1 -
Complementary Therapies in Medicine May 2022To determine whole body vibration influence on human bone density and bone biomarkers. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To determine whole body vibration influence on human bone density and bone biomarkers.
METHODS
We identified studies in Medline, Web of Science, Cumulative Index of Nursing and Allied Health, SPORTDiscus, Embase and Cochrane from inception to November 2021. Human randomized controlled trials involving commercially available whole body vibration platforms were included. Outcomes included bone density mean difference and serum concentrations of biomarkers (Procollagen type 1 N-terminal Propeptides, Osteocalcin, Bone specific alkaline phosphatase, and C-terminal Telopeptide of type 1 collagen). Random effects model (Hedges' g effect-size metric and 95% confidence-intervals) compared whole body vibration effect on bone density and bone biomarkers. Moderator analyses assessed health status, age, menopausal status, vibration type, vibration frequency, and study duration influence.
RESULTS
Meta-analysis of 30 studies revealed bone density improvement after whole body vibration (Hedges' g = 0.11; p = 0.05; 95% CI = 0.00, 0.22). Whole body vibration improved bone density in healthy (Hedges' g = 0.10; p = 0.01; 95% CI = 0.02, 0.17) and postmenopausal women (Hedges' g = 0.09; p = 0.02; 95% CI = 0.01, 0.18). Bone density also increased following side-alternating whole body vibration intervention (Hedges' g = 0.21; p = 0.02; 95% CI = 0.04, 0.37). Whole body vibration had no significant effect on either bone formation biomarkers (Hedges' g = 0.22; p = 0.01; 95% CI = 0.05, 0.40) or bone resorption biomarkers (Hedges' g = 0.03; p = 0.74; 95% CI = -0.17, 0.23).
CONCLUSION
Whole body vibration may be clinically useful as non-pharmacological/adjunct therapy to mitigate osteoporosis risk in healthy postmenopausal females. Additional studies are needed to determine the underlying mechanisms.
Topics: Bone Density; Female; Humans; Physical Therapy Modalities; Vibration
PubMed: 35093509
DOI: 10.1016/j.ctim.2022.102811