A Cochrane review [Abstract] 1 included 27 studies with a total of 3 075 subjects. The aim of the review was to assess the benefits and harms of bisphosphonates for the prevention and treatment of glucocorticoid-induced osteoporosis in adults. Bisphosphonates reduced the risk of vertebral fractures, but made little or no difference in preventing nonvertebral fractures (table T1). They prevented and treated corticosteroid-induced bone loss at both the lumbar spine and femoral neck. There was no statistically significant differences in the occurrence of serious adverse events or withdrawals due to adverse events.
| Outcome | Relative efffect (95% CI) | Assumed risk - control | Corresponding risk - bisphosphonates (95% CI) | NNTB (95% CI) | Participants (studies) |
|---|---|---|---|---|---|
| Incident vertebral fractures (radiographic follow-up 12-24 months) | RR 0.57 (0.35 to 0.91) | 77 per 1000 | 44 per 1000(27 to 70) | 31 (20 to 145) | 1 343(12 studies) |
| Incident nonvertebral fractures(radiographic follow-up 12-24 months) | RR 0.79 (0.47 to 1.33) | 55 per 1000 | 42 per 1000(25 to 69) | - | 1 245(9 studies) |
| Lumbar spine BMD(DEXA follow-up 12 months) | - | Mean per cent change in BMD was -3.19% (-8.08% to 1.70%) | Mean per cent change in BMD was 3.50% higher than control groups (2.90% to 4.10% higher) | 3 (2 to 3) | 2 042(23 studies) |
| Femoral neck BMD(DEXA follow-up 12 months) | - | Mean per cent change in BMD was -1.59% (-10.49% to 7.31%) | Mean per cent change in BMD was 2.06% higher than control groups (1.45% to 2.68% higher) | 5 (4 to 7) | 1 665(18 studies) |
| Serious adverse events(follow-up 12-24 months) | RR 0.91 (0.74 to 1.12) | 162 per 1000 | 147 per 1000(120 to 181) | - | 1 703(15 studies) |
| Withdrawals due to adverse events (follow-up 12-24 months) | RR 1.06 (0.77 to 1.47) | 73 per 1000 | 77 per 1000(56 to 107) | - | 1 790(15 studies) |
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