Bisphosphonates for osteoporosis in people with cystic fibrosis

Conwell, Louise S. and Chang, Anne B. (2009) Bisphosphonates for osteoporosis in people with cystic fibrosis. Cochrane Database of Systematic Reviews, 4: 1-51. doi:10.1002/14651858.CD002010.pub2

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Author Conwell, Louise S.
Chang, Anne B.
Title Bisphosphonates for osteoporosis in people with cystic fibrosis
Journal name Cochrane Database of Systematic Reviews   Check publisher's open access policy
ISSN 1469-493X
Publication date 2009-01-01
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD002010.pub2
Open Access Status File (Publisher version)
Issue 4
Start page 1
End page 51
Total pages 51
Place of publication Oxford, United Kingdom
Publisher John Wiley & Sons
Language eng
Formatted abstract
Background: Osteoporosis is a bone mineralisation disorder 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 longterm oral corticosteroids.

Objectives: To assess the effects of bisphosphonates on the frequency of fractures, BMD, quality of life, adverse events, trial withdrawals, and survival in people with CF. Search strategy: We searched the CF and Genetic Disorders Group Trials Register of references (identified from electronic database searches and handsearches of journals and abstract books) on 29 October 2008. Additional searches of Pubmed were performed on 01 November 2008.

Selection criteria:
Randomised controlled trials of at least six months duration studying bisphosphonates in people with CF. Data collection and analysis: Two authors independently selected trials and extracted data. Trial investigators were contacted to obtain missing data.

Main results: Seven trials were identified and five (with a total of 145 adult participants) were included. clinical heterogeneity between studies and not all studies reported all outcomes. Bone pain was the most common adverse event with intravenous agents. Flu-like symptoms were also increased in those taking bisphosphonates. In participants with a lung transplant (one study), intravenous pamidronate did not change the number of new fractures. At axial sites, BMD increased with treatment compared to controls: percentage change in bone mineral density at lumbar spine, MD 6.20 (95% CI 4.28 to 8.12) and femur MD 7.90 (95% CI 5.78 to 10.02).

Authors' conclusions: Oral and intravenous bisphosphonates increase BMD in people with CF. Severe bone pain and flu-like symptoms may occur with intravenous agents. Additional trials are needed to determine if bone pain is more common or severe (or both) with the more potent zoledronate and if corticosteroids ameliorate or prevent these adverse events. Trials in larger populations are needed to determine effects on fracture rate and survival.
Keyword Bone Density [drug effects]
Cystic Fibrosis [complications]
Diphosphonates [therapeutic use]
Fractures, Bone [prevention & control]
Lung Transplantation Osteoporosis [drug therapy]
Randomized Controlled Trials as Topic
Humans
Bone-Mineral Density
Intravenous Pamidronate
Oral Bisphosphonates
Lung Transplantation
Body-Composition
Adult Patients
Children
Adolescents
Alendronate
Prevention
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
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