The sequential antifracturative treatment: a meta-analysis of randomized clinical trials-Reference-Cited by-同舟云学术

The sequential antifracturative treatment: a meta-analysis of randomized clinical trials

Published:2024-01 Issue: Volume:16 Page:
ISSN:1759-720X
Container-title:Therapeutic Advances in Musculoskeletal Disease
language:en
Short-container-title:Therapeutic Advances in Musculoskeletal

Author:

Fassio Angelo¹^ORCID,Gatti Davide²,Biffi Annalisa³⁴,Ronco Raffaella³⁴,Porcu Gloria³⁴,Adami Giovanni²^ORCID,Alvaro Rosaria⁵,Bogini Riccardo⁶,Caputi Achille P.⁷,Cianferotti Luisella⁸,Frediani Bruno⁹,Gonnelli Stefano¹⁰,Iolascon Giovanni¹¹^ORCID,Lenzi Andrea¹²,Leone Salvatore¹³^ORCID,Michieli Raffaella¹⁴,Migliaccio Silvia¹⁵^ORCID,Nicoletti Tiziana¹⁶,Paoletta Marco¹¹^ORCID,Pennini Annalisa⁵,Piccirilli Eleonora¹⁷¹⁸^ORCID,Rossini Maurizio²^ORCID,Brandi Maria Luisa⁸,Corrao Giovanni³⁴,Tarantino Umberto¹⁷¹⁸

Affiliation:

1. Rheumatology Unit, University of Verona, Piazzale A Scuro, Policlinico GB Rossi, Verona 37134, Italy

2. Rheumatology Unit, University of Verona, Verona, Italy

3. Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano–Bicocca, Milan, Italy

4. Unit of Biostatistics, Epidemiology, and Public Health, Department of Statistics and Quantitative Methods, University of Milano–Bicocca, Milan, Italy

5. Department of Biomedicine and Prevention, University of Rome ‘Tor Vergata’, Rome, Italy

6. Local Health Unit Umbria, Perugia, Italy

7. Department of Pharmacology, School of Medicine, University of Messina, Messina, Italy

8. Italian Bone Disease Research Foundation, Florence, Italy

9. Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, Azienda Ospedaliero-Universitaria Senese, University of Siena, Siena, Italy

10. Department of Medicine, Surgery and Neuroscience, Policlinico Le Scotte, University of Siena, Siena, Italy

11. Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy

12. Department of Experimental Medicine, Sapienza University of Rome, Viale del Policlinico, Rome, Italy

13. AMICI Onlus, Associazione Nazionale per le Malattie Infiammatorie Croniche dell’Intestino, Milan, Italy

14. Italian Society of General Medicine and Primary Care, Florence, Italy

15. Department of Movement, Human and Health Sciences, Foro Italico University, Rome, Italy

16. Coordinamento Nazionale delle Associazioni dei Malati Cronici e rari di Cittadinanzattiva, Rome, Italy

17. Department of Clinical Sciences and Translational Medicine, University of Rome ‘Tor Vergata’, Rome, Italy

18. Department of Orthopedics and Traumatology, ‘Policlinico Tor Vergata’ Foundation, Rome, Italy

Abstract

Background: Subjects with a fragility fracture have an increased risk of a new fracture and should receive effective strategies to prevent new events. The medium-term to long-term strategy should be scheduled by considering the mechanisms of action in therapy and the estimated fracture risk. Objective: A systematic review was conducted to evaluate the sequential strategy in patients with or at risk of a fragility fracture in the context of the development of the Italian Guidelines. Design: Systematic review and meta-analysis. Data sources and methods: PubMed, Embase, and the Cochrane Library were investigated up to February 2021 to update the search of a recent systematic review. Randomized clinical trials (RCTs) that analyzed the sequential therapy of antiresorptive, anabolic treatment, or placebo in patients with or at risk of a fragility fracture were eligible. Three authors independently extracted data and appraised the risk of bias in the included studies. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation methodology. Effect sizes were pooled in a meta-analysis using fixed-effects models. The primary outcome was the risk of refracture, while the secondary outcome was the bone mineral density (BMD) change. Results: In all, 17 RCTs, ranging from low to high quality, met our inclusion criteria. A significantly reduced risk of fracture was detected at (i) 12 or 24 months after the switch from romosozumab to denosumab versus placebo to denosumab; (ii) 30 months from teriparatide to bisphosphonates versus placebo to bisphosphonates; and (iii) 12 months from romosozumab to alendronate versus the only alendronate therapy (specifically for vertebral fractures). In general, at 2 years after the switch from anabolic to antiresorptive drugs, a weighted BMD was increased at the lumbar spine, total hip, and femoral neck site. Conclusion: The Task Force formulated recommendations on sequential therapy, which is the first treatment with anabolic drugs or ‘bone builders’ in patients with very high or imminent risk of fracture.

Funder

The Italian guideline was funded by ALTIS Omnia Pharma Service, which did not affect the content of the document.

Publisher

SAGE Publications

Link

https://journals.sagepub.com/doi/pdf/10.1177/1759720X241234584

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