Article type
Year
Abstract
Introduction:
Objectives: To review the efficacy of calcitonin (subcutaneous or nasal) for the treatment and prevention of corticosteroid-induced osteoporosis.
Methods: We conducted a search of Medline, the Cochrane Controlled Trials Register and Embase using the Cochrane Musculoskeletal Group search strategy for randomized controlled trials (RCTs) up to May 1998. We also searched bibliographic references and consulted content experts. Two independent reviewers selected RCTs which met predetermined inclusion criteria. These two reviewers independently extracted data using predetermined forms and assessed methodological quality of randomization, blinding and dropouts. Three authors have been contacted for further information. For dichotomous outcomes, relative risks (RR) were calculated. For continuous data, weighted mean differences (WMD) of the percentage change from baseline were calculated. We decided a priori to use random effects models for all outcomes.
Results: Eight trials met the inclusion criteria, including 185 patients randomized to calcitonin and 190 to placebo. One trial published in abstract form has not yet been included in the analysis due to insufficient data. The median methodologic quality was three out of a maximum of five points. Calcitonin was more effective than placebo at preserving bone mass at the lumbar spine after 12 and 24 months of therapy with a WMD 3.2 (95% CI: 0.4 to 6.1) and 5.2 (95% CI: -1.3 to 11.6). The relative risk of fractures was not significantly different between calcitonin and placebo with a relative risk of 0.7 (95% CI: 0.3 to 1.8) for vertebral and 0.51 (95% CI: 0.1 to 1.9) for nonvertebral fractures. Bone density at the femoral neck was not different between placebo and calcitonin treated groups. Subgroup analyses will be conducted to explore the effects of methodological quality, mean age and dose of calcitonin. Toxicity data will be presented.
Discussion: Calcitonin appears to preserve bone mass in the first two years of glucocorticoid therapy at the lumbar spine, but not at the femoral neck. Efficacy of calcitonin for fracture prevention remains to be established.
Objectives: To review the efficacy of calcitonin (subcutaneous or nasal) for the treatment and prevention of corticosteroid-induced osteoporosis.
Methods: We conducted a search of Medline, the Cochrane Controlled Trials Register and Embase using the Cochrane Musculoskeletal Group search strategy for randomized controlled trials (RCTs) up to May 1998. We also searched bibliographic references and consulted content experts. Two independent reviewers selected RCTs which met predetermined inclusion criteria. These two reviewers independently extracted data using predetermined forms and assessed methodological quality of randomization, blinding and dropouts. Three authors have been contacted for further information. For dichotomous outcomes, relative risks (RR) were calculated. For continuous data, weighted mean differences (WMD) of the percentage change from baseline were calculated. We decided a priori to use random effects models for all outcomes.
Results: Eight trials met the inclusion criteria, including 185 patients randomized to calcitonin and 190 to placebo. One trial published in abstract form has not yet been included in the analysis due to insufficient data. The median methodologic quality was three out of a maximum of five points. Calcitonin was more effective than placebo at preserving bone mass at the lumbar spine after 12 and 24 months of therapy with a WMD 3.2 (95% CI: 0.4 to 6.1) and 5.2 (95% CI: -1.3 to 11.6). The relative risk of fractures was not significantly different between calcitonin and placebo with a relative risk of 0.7 (95% CI: 0.3 to 1.8) for vertebral and 0.51 (95% CI: 0.1 to 1.9) for nonvertebral fractures. Bone density at the femoral neck was not different between placebo and calcitonin treated groups. Subgroup analyses will be conducted to explore the effects of methodological quality, mean age and dose of calcitonin. Toxicity data will be presented.
Discussion: Calcitonin appears to preserve bone mass in the first two years of glucocorticoid therapy at the lumbar spine, but not at the femoral neck. Efficacy of calcitonin for fracture prevention remains to be established.