RESUMO
BACKGROUND:Comparison of the incidence of fracture can be used as a manner to evaluate the therapeutic effects of anti-osteoporosis drugs. At present, there are a few network meta-analysis on different kinds of anti-osteoporosis drugs. OBJECTIVE:To comprehensively evaluate the risks of different anti-osteoporosis drugs in reducing the vertebral and non-vertebral fractures in postmenopausal women by applying Network Meta-analysis. METHODS: We retrieved The Cochrane Library, PubMed, EMbase, Wanfang, China Biology Medicine, VIP and China National Knowledge Infrastructure for randomized controled trials about vertebral and non-vertebral fractures in postmenopausal women taking anti-osteoporosis drugs. Retrieval time was from building a database to July 2014. Two reviewers extracted and assessed independently the outcomes and quality of included trials according to inclusion and exclusion criteria. We used random effects Bayesian models and fixed effects Bayesian model in WinBUGS 1.4.3 combined R 3.03 software in the network meta-analysis. RESULTS AND CONCLUSION:Forty-six randomized controled trials on vertebral fracture and forty-two randomized controled trials on non-vertebral risk reduction with bisphosphonates (alendronate, risedronate, ibandronate, etidronate, and zoledronic acid), parathyroid hormone (teriparatide), biologics (denosumab), or selective estrogen receptor modulators (raloxifene, bazedoxifene) were identified by a systematic review. Individual study results were pooled in a network meta-analysis to indirectly compare treatment effects in postmenopausal women. The odd ratio and 95% confidence interval of drugs were estimated using random effects Bayesian models in WinBUGS 1.4.3. Zoledronic acid was best in the prevention of vertebral fractures. Risedronate reduced the risk of non-vertebral fracture in postmenopausal women better than other drugs. However, current network meta-analysis cannot give a certain conclusion. A large perspective study designed specialy for confirmation is needed to confirm the results of our study.
RESUMO
BACKGROUND:The reasons for spinal imbalance include spinal deformity, spinal degenerative disease osteoporotic vertebral compression fractures. We believe that the power factor (back muscle) plays a key role in spinal sagittal imbalance. OBJECTIVE:To analyze the reasons for spinal sagittal imbalance by observing clinical manifestations and therapeutic outcomes in patients with osteoporotic vertebral compression fractures. METHODS:A total of 41 patients with osteoporotic compression fractures combined with spinal sagittal imbalance were retrospectively analyzed from January 2012 to May 2013. Al patients were subjected to percutaneous bal oon vertebroplasty under local anesthesia. Before treatment, they received bone density, standing ful-spine lateral X-ray, CT and MR imaging with injured vertebrae as the center. Using standing ful-spine radiographs, the height of anterior border of the injured vertebrae, Cobb angle of kyphosis and improved angle, wedging angle of the injured vertebrae and improved angle were measured. The patients underwent weight loading test and walking test. Preoperative and postoperative data were compared. RESULTS AND CONCLUSION:The patients affected spinal sagittal imbalance symptoms, so the walking distance was significantly shorter than that postoperatively (P<0.05). Moreover, the time of weight loading test was significantly shorter than that postoperatively (P<0.05). In standing ful-spine radiographs, the average difference of Cobb angle was (10.01±0.76)°. The mean difference of vertebral wedging improvement was (4.84±0.40)° (P<0.05). Al patients were fol owed up. Low back pain and sagittal imbalance symptoms were relieved. No severe complications appeared after percutaneous bal oon vertebroplasty. Results indicated that patients with osteoporosis compression fractures can affect the symptoms of spinal sagittal imbalance, which is not only induced by wedging of the injured vertebra. In addition, after percutaneous bal oon vertebroplasty, imbalance symptoms are apparently improved, suggesting that back pain after spinal fracture limits back muscle strength and is an important cause for spinal sagittal imbalance.