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Pharmacological treatment for managing bone health in axial spondyloarthropathy: systematic review and meta-analysis.
Fitzgerald, Gillian E; O'Dwyer, Tom; Mockler, David; O'Shea, Finbar D; Wilson, Fiona.
Afiliação
  • Fitzgerald GE; School of Medicine, Trinity College Dublin, Dublin, Ireland. gifitzge@tcd.ie.
  • O'Dwyer T; Department of Rheumatology, St. James's Hospital, Dublin, Ireland. gifitzge@tcd.ie.
  • Mockler D; Independent Researcher, Dublin, Ireland.
  • O'Shea FD; John Stearne Library, Trinity Centre for Health Sciences, St. James's Hospital, Dublin, Ireland.
  • Wilson F; School of Medicine, Trinity College Dublin, Dublin, Ireland.
Rheumatol Int ; 40(9): 1369-1384, 2020 Sep.
Article em En | MEDLINE | ID: mdl-32556472
ABSTRACT
Axial spondyloarthropathy (axSpA) is associated with an increased prevalence of osteoporosis, but no recommendations exist to guide management. This systematic review and meta-analysis aim to assess the efficacy of pharmacological and non-pharmacological interventions on bone mineral density (BMD) in axSpA. Electronic databases were searched from inception to June 2019 for randomised controlled trials (RCTs) and quasi (q)-RCTs with pharmacological and non-pharmacological interventions. Independent reviewers undertook screening, and risk of bias and quality assessments. Primary outcomes of interest were BMD at spine and hip. Eight studies (two RCTs and six qRCTs) were included (602 participants). Moderate level evidence favoured alendronate over placebo at femoral neck [mean difference (MD) 2.01, 95% CI 0.67 to 3.35], but there was low-level evidence showing no effect at the spine. There was moderate level evidence showing no effect of tumour necrosis factor inhibitors (TNFi) on BMD at total hip (MD - 0.01, 95% CI - 0.06 to 0.04). Very low-level evidence demonstrated no effect of TNFi on spine or femoral neck. Moderate level evidence favoured neridronate over infliximab at the spine (MD 3.26, 95% CI 1.14 to 5.38), but low-level evidence showed no effect at the total hip (MD 2.75, 95% CI - 0.21 to 5.71). There were no eligible studies investigating the efficacy of non-pharmacological interventions. We conditionally recommend alendronate for management of low BMD in axSpA. The balance of evidence does not recommend the use of TNF-inhibitors for treating low BMD. There is a lack of high-quality evidence guiding clinicians treating osteoporosis in axSpA.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Osteoporose / Espondilartrite / Conservadores da Densidade Óssea / Inibidores do Fator de Necrose Tumoral Tipo de estudo: Clinical_trials / Guideline / Risk_factors_studies / Systematic_reviews Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Osteoporose / Espondilartrite / Conservadores da Densidade Óssea / Inibidores do Fator de Necrose Tumoral Tipo de estudo: Clinical_trials / Guideline / Risk_factors_studies / Systematic_reviews Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2020 Tipo de documento: Article