Tolerability of different oral iron supplements: a systematic review.

OBJECTIVE: A systematic review was conducted to analyze the tolerability of several oral iron supplements based on data obtained in available publications and to report the incidence of adverse effects (AEs) for each supplement both overall and gastrointestinal. METHODS: Electronic databases - Medline, the Cochrane Library, and Embase were searched for studies published up to January 2009. Clinical or observational studies reporting data on the tolerability of oral iron supplements were included. Results were described statistically and a quasi-binomial logistic regression model was developed to evaluate and compare the tolerability of the supplements studied. RESULTS: For this review 111 studies were included, with data on 10,695 patients. Ferrous sulfate with mucoproteose had the lowest incidence of AEs (4.1% for overall AEs, 3.7% for gastrointestinal AEs [GAEs]) and was used as the reference supplement in the regression model. Incidence rates of overall AEs for the other supplements were 7.3% for iron protein succinylate [GAEs: 7%; OR for AE compared to the reference supplement, 1.96], 23.5% for ferrous glycine sulfate [GAEs: 18.5%; OR: 5.90], 30.9% for ferrous gluconate [GAEs: 29.9%; OR: 11.06], 32.3% for ferrous sulfate without mucoproteose [GAEs: 30.2%; OR: 11.21], and 47.0% for ferrous fumarate [GAEs: 43.4%; OR: 19.87]. The differences in incidence of AEs between extended-release ferrous sulfate with mucoproteose and all other supplements except iron protein succinylate were statistically significant at p < 0.001. These findings are subject to some limitations as the designs and methodologies of the studies included show heterogeneity among them that has partially been counteracted by the large sample size provided by the substantial number of trials, which is considered a strength in tolerability studies. CONCLUSION: Extended-release ferrous sulfate with mucoproteose appears to be the best tolerated of the different oral iron supplements evaluated.

Efficacy of ossein-hydroxyapatite complex compared with calcium carbonate to prevent bone loss: a meta-analysis.

OBJECTIVE: There is increasing evidence to suggest that ossein-hydroxyapatite complex (OHC) is more effective than calcium supplements in maintaining bone mass. The aim of this meta-analysis was to determine whether OHC has a different clinical effect on bone mineral density (BMD) compared with calcium carbonate (CC). METHODS: A meta-analysis of randomized controlled clinical trials was carried out to evaluate the efficacy of OHC versus CC on trabecular BMD. We identified publications on clinical trials by a search of electronic databases, including MEDLINE (1966-November 2008), EMBASE (1974-November 2008), and the Cochrane Controlled Clinical Trials Register.The primary endpoint was percent change in BMD from baseline. Data were pooled in a random-effects model, and the weighted mean difference was calculated. A sensitivity analysis that excluded trials without full data was performed. RESULTS: Of the 18 controlled trials initially identified, 6 were included in the meta-analysis. There was no significant heterogeneity among the included trials. The percent change in BMD significantly favored the OHC group (1.02% [95% CI, 0.63-1.41], P < 0.00001). These results were confirmed in the sensitivity analysis. CONCLUSIONS: OHC is significantly more effective in preventing bone loss than CC.

Estudio de eficacia y tolerabilidad del anillo vaginal (NuvaRing®) en anticoncepción (ETN@) / Study of the tolerability of the vaginal ring (NuvaRing®) in contraception (ETN@)

Objetivo: Valorar la tolerabilidad del anillo vaginal anticonceptivo (AVA) en una muestra representativa de la población femenina española que utiliza anticoncepción hormonal. Sujetos y métodos: Estudio observacional, prospectivo, multicéntrico realizado en consultas de ginecología y planificación familiar, tanto públicas como privadas, sobre una muestra de 896 mujeres que solicitaron anticoncepción hormonal durante el primer semestre de 2003, eligieron el AVA y fueron seguidas durante 6 ciclos. Para el análisis de los datos se utilizó el paquete estadístico SPSS mediante el cálculo de la t de Student para el análisis comparativo de los datos cuantitativos y de la χ2 de Pearson para las variables cualitativas. Resultados: Tras 6 ciclos de uso, el 72% de las mujeres continúa utilizando el AVA. Sólo el 5% de las mujeres presentaba sangrado intermenstrual a los 6 ciclos y el 85,5% consideró el AVA como el mejor método anticonceptivo, tras su uso. Conclusiones: El AVA es bien tolerado por las mujeres debido a la escasa incidencia de sangrado intermenstrual y al alto grado de satisfacción que genera en sus usuarias

Objective: To evaluate the tolerability of the contraceptive vaginal ring in a representative simple of the Spanish women willing hormonal contraception. Subjects and methods: Observational, prospective, multicenter study carried out in the first six months of 2003 in 896 women starting the use of the vaginal ring and followed during 6 cycles. Results: After 6 cycles of use 72% of women were using the ring. The 5% of women experienced intermenstrual bleeding and 85.5% considered the vaginal ring as the best contraceptive method. Conclusions: The contraceptive vaginal ring is well tolerated by women due to the low incidence of intermenstrual bleeding and the high grade of satisfaction