Efficacy of oral bisphosphonates for preventing hip fracture in disabled patients with neurological diseases: A meta-analysis of randomized controlled trials among the Japanese population

Jun Iwamoto, Tsuyoshi Takeda, Hideo Matsumoto

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Abstract

Objective: Neurological diseases such as amyotrophic lateral sclerosis (ALS), stroke, and Parkinson's disease cause disability and immobilization that increases the risk of hip fracture. The purpose of the present study was to clarify the efficacy of oral bisphosphonates for preventing hip fracture in disabled patients with such neurological diseases. Methods: A literature search (PubMed) was done from 1995 to the present for randomized controlled trials (RCTs), and a meta-analysis was conducted. Results: Seven RCTs met the criteria, including two of etidronate (ALS and stroke), two of alendronate (stroke and Parkinson's disease), and three of risedronate (stroke and Parkinson's disease). All of the RCTs were performed on Japanese patients. According to the results of pooled data analysis, the relative risk (95% confidence interval) of hip fracture in patients receiving etidronate, alendronate, and risedronate treatment compared with placebo or active control treatment was 0.16 (0.03-0.87), 0.29 (0.10-0.80), and 0.24 (0.10-0.58), respectively, suggesting a reduction of risk by more than 70% with oral bisphosphonates. There was no statistical evidence of heterogeneity among RCTs, and publication bias was not identified by the funnel plot and Begg's rank correlation test. No severe adverse events due to oral bisphosphonate treatment were reported. Limitation: It remains uncertain whether the findings are relevant for Western patients with an increased risk of hip fracture due to neurological diseases. Conclusion: A meta-analysis of RCTs suggested that oral bisphosphonate treatment prevents hip fracture in disabled Japanese patients with neurological diseases, including ALS, stroke, and Parkinson's disease. Oral bisphosphonate treatment was well tolerated by such patients.

Original languageEnglish
Pages (from-to)1141-1148
Number of pages8
JournalCurrent Medical Research and Opinion
Volume27
Issue number6
DOIs
Publication statusPublished - 2011 Jun

Fingerprint

Hip Fractures
Diphosphonates
Meta-Analysis
Randomized Controlled Trials
Stroke
Parkinson Disease
Amyotrophic Lateral Sclerosis
Etidronic Acid
Population
Alendronate
Therapeutics
Publication Bias
Risk Reduction Behavior
PubMed
Immobilization
Placebos
Confidence Intervals

Keywords

  • ALS
  • Bisphosphonate
  • Hip fracture
  • Immobilization
  • Parkinson's disease
  • Stroke

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{a3a9f95f742b436e88f208e5e06bd9fb,
title = "Efficacy of oral bisphosphonates for preventing hip fracture in disabled patients with neurological diseases: A meta-analysis of randomized controlled trials among the Japanese population",
abstract = "Objective: Neurological diseases such as amyotrophic lateral sclerosis (ALS), stroke, and Parkinson's disease cause disability and immobilization that increases the risk of hip fracture. The purpose of the present study was to clarify the efficacy of oral bisphosphonates for preventing hip fracture in disabled patients with such neurological diseases. Methods: A literature search (PubMed) was done from 1995 to the present for randomized controlled trials (RCTs), and a meta-analysis was conducted. Results: Seven RCTs met the criteria, including two of etidronate (ALS and stroke), two of alendronate (stroke and Parkinson's disease), and three of risedronate (stroke and Parkinson's disease). All of the RCTs were performed on Japanese patients. According to the results of pooled data analysis, the relative risk (95{\%} confidence interval) of hip fracture in patients receiving etidronate, alendronate, and risedronate treatment compared with placebo or active control treatment was 0.16 (0.03-0.87), 0.29 (0.10-0.80), and 0.24 (0.10-0.58), respectively, suggesting a reduction of risk by more than 70{\%} with oral bisphosphonates. There was no statistical evidence of heterogeneity among RCTs, and publication bias was not identified by the funnel plot and Begg's rank correlation test. No severe adverse events due to oral bisphosphonate treatment were reported. Limitation: It remains uncertain whether the findings are relevant for Western patients with an increased risk of hip fracture due to neurological diseases. Conclusion: A meta-analysis of RCTs suggested that oral bisphosphonate treatment prevents hip fracture in disabled Japanese patients with neurological diseases, including ALS, stroke, and Parkinson's disease. Oral bisphosphonate treatment was well tolerated by such patients.",
keywords = "ALS, Bisphosphonate, Hip fracture, Immobilization, Parkinson's disease, Stroke",
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T1 - Efficacy of oral bisphosphonates for preventing hip fracture in disabled patients with neurological diseases

T2 - A meta-analysis of randomized controlled trials among the Japanese population

AU - Iwamoto, Jun

AU - Takeda, Tsuyoshi

AU - Matsumoto, Hideo

PY - 2011/6

Y1 - 2011/6

N2 - Objective: Neurological diseases such as amyotrophic lateral sclerosis (ALS), stroke, and Parkinson's disease cause disability and immobilization that increases the risk of hip fracture. The purpose of the present study was to clarify the efficacy of oral bisphosphonates for preventing hip fracture in disabled patients with such neurological diseases. Methods: A literature search (PubMed) was done from 1995 to the present for randomized controlled trials (RCTs), and a meta-analysis was conducted. Results: Seven RCTs met the criteria, including two of etidronate (ALS and stroke), two of alendronate (stroke and Parkinson's disease), and three of risedronate (stroke and Parkinson's disease). All of the RCTs were performed on Japanese patients. According to the results of pooled data analysis, the relative risk (95% confidence interval) of hip fracture in patients receiving etidronate, alendronate, and risedronate treatment compared with placebo or active control treatment was 0.16 (0.03-0.87), 0.29 (0.10-0.80), and 0.24 (0.10-0.58), respectively, suggesting a reduction of risk by more than 70% with oral bisphosphonates. There was no statistical evidence of heterogeneity among RCTs, and publication bias was not identified by the funnel plot and Begg's rank correlation test. No severe adverse events due to oral bisphosphonate treatment were reported. Limitation: It remains uncertain whether the findings are relevant for Western patients with an increased risk of hip fracture due to neurological diseases. Conclusion: A meta-analysis of RCTs suggested that oral bisphosphonate treatment prevents hip fracture in disabled Japanese patients with neurological diseases, including ALS, stroke, and Parkinson's disease. Oral bisphosphonate treatment was well tolerated by such patients.

AB - Objective: Neurological diseases such as amyotrophic lateral sclerosis (ALS), stroke, and Parkinson's disease cause disability and immobilization that increases the risk of hip fracture. The purpose of the present study was to clarify the efficacy of oral bisphosphonates for preventing hip fracture in disabled patients with such neurological diseases. Methods: A literature search (PubMed) was done from 1995 to the present for randomized controlled trials (RCTs), and a meta-analysis was conducted. Results: Seven RCTs met the criteria, including two of etidronate (ALS and stroke), two of alendronate (stroke and Parkinson's disease), and three of risedronate (stroke and Parkinson's disease). All of the RCTs were performed on Japanese patients. According to the results of pooled data analysis, the relative risk (95% confidence interval) of hip fracture in patients receiving etidronate, alendronate, and risedronate treatment compared with placebo or active control treatment was 0.16 (0.03-0.87), 0.29 (0.10-0.80), and 0.24 (0.10-0.58), respectively, suggesting a reduction of risk by more than 70% with oral bisphosphonates. There was no statistical evidence of heterogeneity among RCTs, and publication bias was not identified by the funnel plot and Begg's rank correlation test. No severe adverse events due to oral bisphosphonate treatment were reported. Limitation: It remains uncertain whether the findings are relevant for Western patients with an increased risk of hip fracture due to neurological diseases. Conclusion: A meta-analysis of RCTs suggested that oral bisphosphonate treatment prevents hip fracture in disabled Japanese patients with neurological diseases, including ALS, stroke, and Parkinson's disease. Oral bisphosphonate treatment was well tolerated by such patients.

KW - ALS

KW - Bisphosphonate

KW - Hip fracture

KW - Immobilization

KW - Parkinson's disease

KW - Stroke

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