Objective To assess the efficacy and safety of parathyroid hormone (PTH) on bone mineral density (BMD) and fractures in postmenopausal women with osteoporosis. Methods We searched MEDLINE (1966 to March 2008), EMBASE (1974 to March 2008), The Cochrane Library (Issue 1, 2008), Current Controlled Trials, The National Research Register, CBM (1983 to March 2008) and CNKI (1994 to March 2008). Some related journals were hand searched as well. The quality of included randomized controlled trials (RCTs) was evaluated and meta-analysis was conducted by The Cochrane Collaboration’s software RevMan 4.2.10. Results Twelve studies involving 5550 patients were included. PTH alone or in combination with antiresorptive drugs reduced the risk of vertebral fracture (RR=0.34, 95%CI 0.26 to 0.45, Plt;0.000 01), and increased spine BMD (SMD 0.41, 95%CI 0.17 to 0.65, P=0.0009) and femoral neck BMD (SMD 0.13, 95%CI 0.03 to 0.22, P=0.008). The rate of drop out and loss to follow-up because of adverse events was significantly higher in the PTH group (Peto-OR=1.69, 95%CI 1.39 to 2.05, Plt;0.000 01). Conclusion PTH is effective in the prevention and treatment of postmenopausal osteoporosis, especially in patients with preexisting osteoporotic fractures or with very low bone density. PTH alone or in combination with antiresorptive drugs can reduce the risk of vertebral fractures and increase spine and femoral neck BMD. PTH is more effective than alendronate, but these two should not be used as a combined treatment.
Objective To systematically review the efficacy and adverse events of alendronate on bone mineral density and fractures in men with osteoporosis. Methods We electronically searched MEDLINE (1990 to 2005), EMBASE (1990 to 2005), The Cochrane Library (Issue 3, 2005), Controlled Trials Register and The National Research Register, CBM disc, VIP, and CNKI. We also handsearched some related journals. The search was conducted in Nov., 2005. The quality of included randomized controlled trials (RCTs) was evaluated and meta-analysis was conducted by RevMan 4.2.8. Results We identified 7 studies including 817 patients. Sufficient evidence showed that alendronate plus calcium was superior as preventive treatment to calcium in increasing the bone mineral density (SMD 0.59, 95% CI 0.15 to 1.03, P=0.009) of the lumbar spine. The incidence of withdrawal and lost to follow-up due to adverse events of the alendronate plus calcium was lower than that of calcium (RR 0.32, 95% CI 0.11 to 0.87). Two studies showed that alendronate was superior to placebo in increasing the bone mineral density in men with osteoporosis but with no significantly statistical difference in reducing fractures. Two studies showed alendronate was superior to alfacalcidol in increasing the bone mineral density and reducing the vertebral fractures in men with osteoporosis. One study showed alendronate was not superior to calcitonin or alfacalcidol in increasing the bone mineral density in men at high risk of osteoporosis. One study comparing anledronate or parathyroid hormone with combination of these drugs in men with osteoporosis suggested that anledronate wasn’t superior to parathyroid hormone in increasing the bone mineral density, and the combination did not show any difference compared to parathyroid hormone alone. Conclusions Alendronate is more effective in prevention and treatment of men with osteoporosis compared to placebo. Alendronate is more effective than alfacalcidol in increasing bone mineral density and reducingvertebral fractures in men with osteoporosis. Alendronate is not superior to alfacalcidol or calcitonin in increasing the bone mineral density in preventing men osteoporosis. Alendronate compared to combination of parathyroid hormone does not show more effectiveness in increasing the bone mineral density in men with osteoporosis. More RCTs of high quality, especially multiple center trials are needed to generate ber evidence.
Objective To explore the methods of evidence-based individualized treatment for a patient with Graves’ disease. Method We searched The Cochrane Library (Issue 3, 2006), SUMSEARCH (Jan.1980 to Mar. 2006), PubMed (1980 to Mar.2006), CNKI (Jan.1980 to Mar. 2006) and VIP (Jan.1980 to Mar.2006) to identify the best evidence for antithyroid drugs, iodine radioisotopes and thyroidectomy for patients with Graves’ hyperthyroidism and evaluate the quality of available evidence. Results We identified 1 clinical guideline, 1 Cochrane systematic review, 1 meta-analysis and 15 randomized controlled trials. There was no significant difference between the titration regimen and the block-replace regimen in the relapse of hyperthyroidism, while the block-replace regimen was associated with more adverse effects. Prescribing replacement thyroxine, either with or after the anti-thyroid drug treatment, had no significant effect on relapse. Methimazole was more effective than propylthiouracil in the induction of euthyroidism. There was no significant difference in the quality of life between the drugs, 131I and the thyroidectomy therapy, and the relapse was lower with thyroidectomy therapy but the cost was higher. Given the current evidence together with our clinical experience and considering the patient and her family’s values and preferences, methimazole (10 mg tid) was administered to her and then gradually reduced. No obvious adverse effects occurred within 4 months’ follow-up. Conclusion Drugs, radioactive iodine and thyroidectomy are all effective in the treatment of Graves’ hyperthyroidism. Methimazole is an effective and well tolerated drug for the treatment of Graves’ hyperthyroidism and further research into side effect are needed. Prescribing replacement thyroxine has no significant effect on relapse.