European journal of endocrinology · 2026
Effectiveness of anti-osteoporotic medications in the management of glucocorticoid-induced osteoporosis: a systematic review and network meta-analysis on behalf of the ECTS clinical action group.
Сравнительное исследованиеСтатьяNetwork Meta-AnalysisСистематический обзорСистематический обзорNetwork Meta-AnalysisНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Yavropoulou Maria P, Ter Wee Marieke M, Naciu Anda Mihaela, Paccou Julien, Anastasilakis Athanasios D, Gialouri Chrysoula G, Hauser Barbara, Sølling Anne Sophie, D'Oronzo Stella, Rolvien Tim, Lems Willem F
Аннотация
OBJECTIVE: To evaluate and compare the efficacy of anti-osteoporotic-medications (AOM) for the prevention and treatment of glucocorticoid-induced-osteoporosis (GIOP).
DESIGN: Systematic review and network-meta-analysis conducted in accordance with PRISMA-NMA guidelines (ProsperoID: CRD42024502298).
METHODS: MEDLINE, Embase, and Web of Science were searched from inception to December 2025 to identify randomized-controlled-trials and comparative-observational-studies evaluating AOM in adults receiving oral glucocorticoids (GC). Outcomes included percentage change in areal bone- mineral-density (aBMD) at the lumbar-spine (primary), femoral-neck, and total-hip. A random effects network-meta-analysis was performed, integrating direct and indirect comparisons across AOM. Certainty of evidence was assessed using the CINeMA framework.
RESULTS: Thirty-one studies (28 randomized-controlled-trials and 3 observational-studies) involving 5260 participants (age-range: 29.6-70.6 years, 72.5% females) were included. All AOM were superior to placebo or calcium/vitaminD supplementation in increasing lumbar-spine aBMD. Teriparatide demonstrated the greatest efficacy compared with alendronate (effect-size: 3.8; 95% CI: 2.9-4.6), risedronate (4.0; 95% CI: 2.9-5.1), denosumab (1.5; 95% CI: 0.1-2.9), and zoledronate (2.4; 95% CI: 1.1-3.6), while no significant difference was observed with romosozumab (0.3; 95% CI: -2.1 to 1.4). Among antiresorptive-medications, zoledronate and denosumab showed greater efficacy than oral bisphosphonates, which demonstrated modest positive effects. In sensitivity analyses restricted to established GIOP, defined as GC users ≥3months, teriparatide and romosozumab remained superior to antiresorptive-medications. Evidence for total-hip and femoral-neck aBMD outcomes was limited by substantial network inconsistency (mostly missing data). Included studies were underpowered to assess difference in fracture outcomes.
CONCLUSIONS: This network-meta-analysis demonstrates a clear gradient of efficacy among AOM in GIOP, with anabolic and potent antiresorptive-medications producing the largest gains in lumbar-spine aBMD supporting current ECTS recommendations advocating risk-stratified treatment selection.
DESIGN: Systematic review and network-meta-analysis conducted in accordance with PRISMA-NMA guidelines (ProsperoID: CRD42024502298).
METHODS: MEDLINE, Embase, and Web of Science were searched from inception to December 2025 to identify randomized-controlled-trials and comparative-observational-studies evaluating AOM in adults receiving oral glucocorticoids (GC). Outcomes included percentage change in areal bone- mineral-density (aBMD) at the lumbar-spine (primary), femoral-neck, and total-hip. A random effects network-meta-analysis was performed, integrating direct and indirect comparisons across AOM. Certainty of evidence was assessed using the CINeMA framework.
RESULTS: Thirty-one studies (28 randomized-controlled-trials and 3 observational-studies) involving 5260 participants (age-range: 29.6-70.6 years, 72.5% females) were included. All AOM were superior to placebo or calcium/vitaminD supplementation in increasing lumbar-spine aBMD. Teriparatide demonstrated the greatest efficacy compared with alendronate (effect-size: 3.8; 95% CI: 2.9-4.6), risedronate (4.0; 95% CI: 2.9-5.1), denosumab (1.5; 95% CI: 0.1-2.9), and zoledronate (2.4; 95% CI: 1.1-3.6), while no significant difference was observed with romosozumab (0.3; 95% CI: -2.1 to 1.4). Among antiresorptive-medications, zoledronate and denosumab showed greater efficacy than oral bisphosphonates, which demonstrated modest positive effects. In sensitivity analyses restricted to established GIOP, defined as GC users ≥3months, teriparatide and romosozumab remained superior to antiresorptive-medications. Evidence for total-hip and femoral-neck aBMD outcomes was limited by substantial network inconsistency (mostly missing data). Included studies were underpowered to assess difference in fracture outcomes.
CONCLUSIONS: This network-meta-analysis demonstrates a clear gradient of efficacy among AOM in GIOP, with anabolic and potent antiresorptive-medications producing the largest gains in lumbar-spine aBMD supporting current ECTS recommendations advocating risk-stratified treatment selection.