Bisphosphonates for osteoporosis in people with cystic fibrosis

Conwell, Louise S. and Chang, Anne B. (2012) Bisphosphonates for osteoporosis in people with cystic fibrosis. Cochrane Database of Systematic Reviews, 4: CD002010 -1-CD002010 -62.

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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 2012-04
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1002/14651858.CD002010.pub3
Issue 4
Start page CD002010 -1
End page CD002010 -62
Total pages 62
Place of publication London, United Kingdom
Publisher John Wiley & Sons
Collection year 2013
Language eng
Formatted abstract Background
Osteoporosis is a bone mineralisation disorder occurring in about one third of adults with cystic fibrosis. Bisphosphonates can increase
bone mineral density and decrease the risk of new fractures in post-menopausal women and people receiving long-term oral corticosteroids.

Objectives
To assess the effects of bisphosphonates on the frequency of fractures, bone mineral density, quality of life, adverse events, trial
withdrawals, and survival in people with cystic fibrosis.

Search methods
We searched the Cystic Fibrosis and Genetic Disorders Group Trials Register of references (identified from electronic database searches and handsearches of journals and abstract books) on 15 February 2012. Additional searches of PubMed were performed on 14 May 2011.

Selection criteria
Randomised controlled trials of at least six months duration studying bisphosphonates in people with cystic fibrosis.

Data collection and analysis
Two authors independently selected trials and extracted data. Trial investigators were contacted to obtain missing data.

Main results
Nine trials were identified and seven (with a total of 237 adult participants) were included. Data were combined (when available) from six included studies in participants without a lung transplant. Data showed that there was no significant reduction in fractures between treatment and control groups at 12 months, odds ratio 0.72 (95% confidence interval 0.13 to 3.80). No fractures were reported in studies with follow-up at 24 months. However, in patients taking bisphosphonates after six months the percentage change in bone mineral density increased at the lumbar spine, mean difference 4.61 (95% confidence interval 3.90 to 5.32) and at the hip or femur, mean difference 3.35 (95% confidence interval 1.63 to 5.07); but did not significantly change at the distal forearm, mean difference -0.49 (95% confidence interval -2.42 to 1.45). In patients taking bisphosphonates, at 12 months the percentage change in bone mineral density increased at the lumbar spine, mean difference 6.10 (95% confidence interval 5.10 to 7.10) and at the hip or femur, mean difference 4.35 (95% confidence interval 2.99 to 5.70). At 24 months, in patients treated with bisphosphonates the percentage change in bone mineral density also increased at the lumbar spine, mean difference 5.49 (95% confidence interval 4.38 to 6.60) and at the hip or femur, mean difference 6.05 (95% confidence interval 3.74 to 8.36). There was 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, bone mineral density increased with treatment compared to controls: percentage change in bone mineral density at lumbar spine, mean difference 6.20 (95% confidence interval 4.28 to 8.12); and femur mean difference 7.90 (95% confidence interval 5.78 to 10.02).

Authors’ conclusions
Oral and intravenous bisphosphonates increase bone mineral density in people with cystic fibrosis. 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. Additional trials are also required to further assess gastrointestinal adverse effects associated with oral bisphosphonates. Trials in larger populations are needed.
Keyword Bone Density [drug effects]
Bone Density Conservation Agents [therapeutic use]
Cystic Fibrosis [complications]
Diphosphonates [therapeutic use]
Fractures, Bone [prevention & control]
Osteoporosis [drug therapy]
Bone-Mineral Density
Intravenous Pamidronate
Oral Bisphosphonates
Alendronate
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published Online: 18 April 2012. Article Number: CD002010

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2013 Collection
School of Medicine Publications
 
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