Objective To evaluate the efficacy of bisphosphonates in treating patients with Multiple Myeloma. Methods The databases including The Cochrane Library, PubMed, EMBASE, CBM, and CNKI were searched. Quality assessment and data extraction were conducted by two reviewers independently, and disagreement, if any, was resolved by discussion. Meta-analyses were performed for homogeneous studies. Results Eleven RCTs were included, all of which came from abroad. The methodological quality of the included studies was good. The baseline data of each trial were comparable. Meta-analyses showed that, the pooled analysis of the published evidence demonstrated the beneficial effect of bisphosphonates on prevention of pathological vertebral fractures (OR=0.59, 95%CI 0.45 to 0.78, P=0.000 1) and on relieving pain (OR=0.59, 95%CI 0.46 to 0.76, P=0.000 05). However, the analysis of the effect of bisphosphonates on pain was based on clinically heterogeneous data which must be interpreted with caution. Meanwhile, there was no significant effect of bisphosphonates on mortality (OR=0.99, 95%CI 0.88 to 1.12, P=0.9) and hypercalcemia (OR=0.76, 95%CI 0.56 to 1.03, P=0.07). Conclusions Adding bisphosphonates to the treatment of myeloma can reduce pathological vertebral fractures and pain, but is not helpful to mortality and hypercalcemia.
ObjectiveTo evaluate the efficacy and safety of bisphosphonates in preventing and treating glucocorticoid induced osteoporosis. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 1, 2016), CNKI, WanFang Data and VIP were searched to collect randomized controlled trials (RCTs) related bisphosphonates for the prevention and treatment of glucocorticoid induced osteoporosis from inception to January 2016. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias of included studies. Meta-analysis was performed using RevMan 5.3 software. ResultsA total of 20 RCTs were included, which involved 2 330 patients. The results of meta-analysis showed that, compared with the placebo group, the bisphosphonates group could significantly increase the bone mineral density (BMD) at lumbar and femoral neck (MD=3.70, 95%CI 2.65 to 4.75, P<0.000 01; MD=2.18, 95%CI 1.30 to 3.06, P<0.000 01), but the bisphosphonates group could not decrease the incidence rates of vertebral fracture or non-vertebral fracture (OR=0.66, 95%CI 0.38 to 1.16, P=0.15; OR=0.73, 95%CI 0.42 to 1.28, P=0.28). There were no significant differences in the incidence rates of total adverse reactions and total severe adverse reactions between the two groups (OR=0.89, 95%CI 0.62 to 1.28, P=0.53; OR=0.93, 95%CI 0.62 to 1.39, P=0.72). ConclusionCurrent evidence shows that, compared with placebo, bisphosphonates canld effectively prevent and treat the decrease of bone mineral density of glucocorticoid induced osteoporosis, not decrease the incidence of fracture, but not increase the incidence of adverse reactions.