MADRID – Bisphosphonates mitigate the damaging effects of glucocorticoid on bone, boosting bone mineral density and reducing the risk of fracture by up to 33%, compared with placebo, according to a systematic review and meta-analysis.
The review of 11 randomized, controlled trials found that bisphosphonates consistently improved bone outcomes among patients taking prednisone, Anas Makhzoum, MD, said at the European Congress of Rheumatology.
The primary outcomes of these trials were mean percentage change in bone mineral density at lumbar spine and femoral neck, and fracture incidence.
The drugs examined were ibandronate, alendronate, risedronate, etidronate, and clodronate. The mean duration of these trials was 71 weeks. Patients took a mean steroid dose of 15 mg.
Dr. Makhzoum, a resident at Queen’s University, Kingston, Ont., pooled nine of these trials for the outcome of mean percentage change in lumbar spine bone mineral density. The pooled mean percentage change of lumbar spine consistently favored bisphosphonates, compared with placebo, with a mean, statistically significant difference of approximately 4%.
Six studies were pooled for the outcome of mean percentage change in femoral neck bone mineral density. The pooled mean percentage change consistently favored bisphosphonates, with a mean, statistically significant difference of 2.95% relative to placebo.
Seven studies were pooled for outcome of incident fracture and the results consistently favored bisphosphonates, with a mean, statistically significant 33% decrease in the risk of a new fracture, compared with the placebo group (relative risk, 0.66).
“Bisphosphonates remain the standard of care for prevention and treatment of bone loss in patients on chronic steroids treatment,” Dr. Makhzoum noted.
He had no financial disclosures.