Objective To evaluate and select essential medicine for middle-aged and elderly women with primary osteoporosis using evidence-based methods based on the burden of disease. Methods By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence. Results (1) 18 guidelines were included, 14 of which were evidence-based or based on expert consensus. Recommended medicines included bisphosphonates, calcitonin, estrogen, parathyroid hormone, selective estrogen receptor modulator, strontium and Chinese patent drug. (2) A result of one quasi-RCT (very low quality) indicated that caltrate D had a better effect on elderly women with primary osteoporosis than calcium gluconate in improving bone mineral density (BMD) (MD=0.04, 95%CI 0.02 to 0.06) and ameliorating bone ache ( RR=2.64, 95%CI 1.40 to 4.96). A few cases treated by caltrate D presented with adverse reaction such as gastrointestinal discomfort, poor appetite, constipation and nausea which disappeared later. Caltrate D (calcium carbonate D3) with good applicability cost 1.00 yuan daily. (3) A result of one RCT (low quality) indicated that alendronate had a better effect than caltrate D in improving L2-L4 BMD (MD=0.06, 95%CI 0.017 to 0.10) and ameliorating bone ache (RR=1.8, 95%CI 1.40 to 2.52). A result of two RCTs (moderate quality) indicated that alendronate plus calcium carbonate plus vitamin D6 had a better effect than calcium carbonate plus vitamin D in improving L2-L4 BMD (MD=0.05, 95%CI 0.02 to 0.08) and reducing blood alkaline phosphatase (MD=–31.9, 95%CI –54.99 to –8.81). There were slight adverse effects mainly including gastrointestinal reaction. Alendronate with fairly poor applicability cost 2.67 yuan daily. (4) A result of one RCT (moderate quality) indicated that after a 3-month treatment, Xian Ling Gu Bao Jiao Nang (name of a Chinese patent drug, abbreviated as XLGB) plus calcium preparation had a better effect than calcium preparation alone (MD=10, 95%CI 0.05 to 0.15). A result of one RCT (moderate quality) indicated that given for 3 to 6 months, XLGB plus calcium preparation was superior to calcium preparation alone in increasing the density of Ward’s triangle and the great femoral trochanter. A result of one RCT (low quality) indicated that XLGB plus calcitriol had a better effect than calcitriol alone in pain relief (RR=1.26, 95%CI 1.04 to 1.52). There were slight adverse effects mainly including reaction in the digestive system, the circulatory system and the skin. XLGB with good applicability cost 4.58 yuan daily. Conclusion We offer a weak recommendation for alendronate applied to middle-aged and elderly women with primary osteoporosis and pain and fracture caused by primary osteoporosis. We also offer a b recommendation for caltrate D and XLGB applied to middle-aged and elderly women with primary osteoporosis and pain and fracture caused by primary osteoporosis. In addition, we propose that the census on elder people with osteoporosis in rural areas should be carried out. More clinical and pharmacoeconomic studies of large-sample, high-quality on alendronate and its calcium preparation for adult osteoporosis are needed in China.
Objective To explore the correlation of risk factors affecting the L2-4BMD level in patients with post-menopausal osteoporosis. Methods Ninety-two patients with post-menopausal osteoporosis were surveyed with a retrospective questionnaire. We used the findings to set up a multiple stepwise regression model and perform correlation analysis with L2-4BMD levels as the dependent variable and risk factors as the independent variables. Results Assuming that age has a definite effect on the L2-4BMD level of menopausal women, menopausal age limit, history of milk drinking, menopausal age, menarche age, fracture history and bend-back entered into the multiple stepwise regression equation. Conclusions Menopausal age limit, history of milk drinking, menopausal age, menarche age, fracture history, and bend-back influence patients with menopausal osteoporosis.The menopausal age limit is especially important. Awareness of the risk factors of osteoporosis should be raised.
ObjectiveTo overview the reporting and methodology quality of systematic reviews/meta-analysis on acupuncture in the treatment of primary osteoporosis (POP).MethodsPubMed, EMbase, The Cochrane Library, CBM, WanFang Data, CNKI and VIP databases were electronically searched to collect systematic reviews/meta-analysis on acupuncture in the treatment of POP from inception to July 2018. Two reviewers independently screened literature, extracted data, and assessed the quality of systematic reviews. A Measurement Tool to Assess Systematic Reviews (AMSTAR) methodological quality score and Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) were used to assess the methodological quality and reporting quality of the systematic reviews, along with the risk of homogeneity and publication bias.ResultsA total of 11 systematic reviews/meta-analysis were included and multiple evaluations of the radar plot showed that the quality average rank scored 7.68. The major problems in studies were lack of items registration, imperfect search strategies and selection bias and so on.ConclusionThe quality of systematic reviews/meta-analysis of acupuncture in the treatment of POP is insufficient, indicating that the methodological and reporting quality of systematic reviews should be further strengthened.
Primary osteoporosis is a common metabolic disease in China, causing immense disease and economic burden to patients, their families and the society. Prevention is an important strategy to reduce the disease burden of primary osteoporosis. Calcium, as a basic element for maintaining bone health, plays an important role in the prevention of primary osteoporosis. This guideline was initiated by the Chinese Pharmaceutical Society Evidence-based Pharmacy Specialised Committee. The standard methodology for the development of evidence-based clinical practice guidelines of the World Health Organization (WHO) was employed. A multidisciplinary guideline working group was formed. Delphi method was used to select and eventually identified 15 key clinical questions. Systematic evaluation was carried out on each of the key clinical question and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to formed 15 recommendations, providing guidance for standardizing the clinical practice of calcium supplementation in prevention of primary osteoporosis in adults in China.