Meta-analyses of therapies for @entity170 . VI. Meta-analysis of @entity175 for the treatment of XXXX .

@entity1 @entity175 @entity174 @entity170 @entity460 @entity560
OBJECTIVE: To review the effect of @entity175 on bone density and @entity174 in postmenopausal @entity1 . DATA SOURCE: We searched MEDLINE and EMBASE from 1966 to 2000 and examined citations of relevant articles and the proceedings of international @entity170 meetings. We contacted @entity170 investigators to identify additional studies and primary authors for unpublished data. STUDY SELECTION: We included 30 studies that randomized @entity1 to @entity175 or an alternative (placebo or @entity460 and/or @entity560 ) and measured bone density or @entity174 incidence for at least 1 yr. DATA EXTRACTION: For each trial, three independent reviewers assessed the methodological quality and abstracted data. DATA SYNTHESIS: @entity175 reduced the incidence of @entity174 , with a pooled relative risk (RR) of 0.46 [95% confidence interval (CI) 0.25-0.87, P = 0.02, n = 1404, 4 trials]. However, the RR from the one relatively large randomized controlled trial (RCT) was 0.79 (95% CI 0.62-1.00, P = 0.05, n = 1108). For nonvertebral @entity174 , the pooled RR was 0.52 (95% CI 0.22-1.23, P = 0.14, n = 1481, 3 trials). Once again, the single large trial showed a less impressive effect than the smaller trials (RR 0.80, 95% CI 0.59-1.09, P = 0.16, n = 1245). For bone density of the lumbar spine, the pooled weekly dose of 250 to 2800 IU per week resulted in significant increase in the weighted mean difference (WMD) of 3.74 (2.04-5.43, P < 0.01, n = 2260, 24 trials). The combined forearm showed a similar effect, with a WMD of 3.02 (95% CI 0.98-5.07, P < 0.01, n = 468, 9 trials). At the femoral neck, the pooled weighted mean difference showed a nonsignificant trend toward benefit, WMD 3.80 (95% CI -0.32-7.91, P = 0.07, 9 trials, n = 513). Methodologically weaker studies tended to show greater effects on bone density, and the lumbar spine results suggested the possibility of publication bias. CONCLUSIONS: @entity175 likely increases bone density in postmenopausal @entity1 predominantly at the lumbar spine and forearm for weekly doses of greater than 250 IU, although the true effect may be smaller than the pooled estimate would suggest. @entity175 likely reduces the risk of @entity174 ; its effect on nonvertebral @entity174 remains uncertain.
