【医学课件】糖皮质激素性骨质疏松症的诊治进展GIO.ppt

* We evaluated all formulations of vitamin D, including its active metabolites and analogs. A systematic search for published and unpublished studies was conducted using MEDLINE 1966–December 1997 , bibliographic references, abstracts from proceedings of recent national meetings, and contact with pharmaceutical companies and content experts. We included all randomized controlled trials lasting at least 6 months and reporting extractable results , of patients receiving oral corticosteroids, that compared vitamin D with either 1 no therapy or calcium alone, or 2 bisphosphonates, calcitonin, or fluoride. The primary outcome measure of interest was change in lumbar spine bone mineral density. Results. We found a moderate beneficial effect of vitamin D plus calcium versus no therapy or calcium alone 9 trials effect size 0.60; 95% confidence interval [95% CI] 0.34, 0.85; P 0.0001 . Vitamin D plus calcium is superior to no therapy or calcium alone in the management of corticosteroid-induced osteoporosis. Vitamin D is less effective than some osteoporosis therapies. Therefore, treatment with vitamin D plus calcium, as a minimum, should be recommended to patients receiving long-term corticosteroids. When we reconverted these results, the pooled effect was equivalent to a 3.2% difference in the percent change in BMD between treatment and control, in favor of vitamin D plus calcium treatmen * We evaluated all formulations of vitamin D, including its active metabolites and analogs. A systematic search for published and unpublished studies was conducted using MEDLINE 1966–December 1997 , bibliographic references, abstracts from proceedings of recent national meetings, and contact with pharmaceutical companies and content experts. We included all randomized controlled trials lasting at least 6 months and reporting extractable results , of patients receiving oral corticosteroids, that compared vitamin D with either 1 no therapy or calcium alone, or 2 bisphosphonates,