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Bisphosphonates for osteoporosis in people with cystic fibrosisBrenckmann C, Papaioannou A
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SummaryBisphosphonates are effective in increasing bone density in people with cystic fibrosis but more research is neededCystic fibrosis (CF) is a serious genetic disorder that affects cells in the exocrine glands (sweat glands and others). Osteoporosis is a disorder of the bones that can lead to reduced bone density and brittleness and is a common problem for people with CF. Bisphosphonates are drugs that increase bone density, they are used to treat osteoporosis caused by menopause or the use of corticosteroid drugs. The review of trials found using bisphosphonates such as pamidronate for osteoporosis is promising for people with CF. However, these drugs cause severe bone pain in people not using corticosteroids. More research is needed.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
October 23. 2001 AbstractBackgroundOsteoporosis is a disorder of bone mineralisation occurring in about one third of adults with cystic fibrosis (CF). Bisphosphonates can increase bone mineral density (BMD) and decrease the risk of new fractures in post-menopausal women and people receiving long-term oral corticosteroids. ObjectivesTo assess the effects of bisphosphonates on the frequency of fractures, BMD, quality of life, adverse events, trial withdrawals, and survival in adults with CF. Search strategyWe searched the CF and Genetic Disorders Group trials register of references identified from electronic database searches and handsearching of journals and abstract books. Abstract books for osteoporosis conferences were handsearched by the reviewers. Most recent search of Group's register: August 2004. Selection criteriaRandomised controlled trials of at least six months duration studying bisphosphonates in adults with CF and reporting relevant outcomes. Data collection and analysisTwo reviewers abstracted data. Authors were contacted to obtain missing data. Main resultsTwo trials with a total of 65 participants were identified and included. One examined participants without lung transplant, the other studied participants with lung transplant. Participants in both trials received intravenous pamidronate every three months. In participants without a lung transplant, after six months of pamidronate compared to control BMD increased in the lumbar spine, weighted mean difference (WMD) for per cent change, 5.80 (95% CI 2.91 to 8.69) and in the hip, WMD 3.00 (95% CI 0.60 to 5.40); but decreased in distal forearm, WMD -1.70 (95% CI -3.66 to 0.26). Bone pain was the most common adverse event occurring in 11 out of 15 participants not using corticosteroids, relative risk (RR) 24.44 (95% CI 1.57 to 381.48). There was no significant difference in survival, RR 1.00 (95% CI 0.83 to 1.20), although this may be due to short follow up and small sample size. In participants with a lung transplant, pamidronate did not change the number of new fractures: non-vertebral RR 0.56 (95% CI 0.17 to 1.89); vertebral RR 3.38 (95% CI 0.39 to 29.29). BMD at axial sites increased with treatment compared to controls: lumbar spine WMD (for per cent change in BMD) 6.20 (95% CI 4.28 to 8.12); femur WMD 7.90 (95% CI 5.78 to 10.02). Authors' conclusionsIntravenous pamidronate increases BMD at axial sites in people with CF, although it can cause severe bone pain in participants not receiving corticosteroids. Additional trials in larger populations are needed to determine effects on fracture rate and survival. |