Meta-analyses of therapies for @entity170 . II. Meta-analysis of @entity561 for the treatment of postmenopausal XXXX .

@entity1 @entity3604 @entity174 @entity561 @entity170
OBJECTIVE: To review the effect of @entity561 on bone density and @entity174 in postmenopausal @entity1 . DATA SOURCE: We searched MEDLINE, EMBASE, Current Contents, and the Cochrane Controlled trials registry from 1980 to 1999, and we examined citations of relevant articles and proceedings of international meetings. STUDY SELECTION: We included 11 trials that randomized @entity1 to @entity561 or placebo and measured bone density for at least 1 yr. DATA EXTRACTION: For each trial, three independent reviewers assessed the methodological quality and abstracted data. DATA SYNTHESIS: The pooled relative risk (RR) for @entity174 in @entity1 given 5 mg or more of @entity561 was 0.52 [95% confidence interval (CI), 0.43-0.65]. The RR of @entity174 in @entity1 given 10 mg or more of @entity561 was 0.51 (95% CI 0.38-0.69), an appreciably greater effect than for the 5 mg dose. We found a similar reduction in RR across nonvertebral fracture types; in particular, RR reductions for @entity174 traditionally thought to be " @entity3604 ," such as hip and forearm, were very similar to RR reductions for "nonosteoporotic" @entity174 . Individual studies showed similar results, reflected in the P values of the test of heterogeneity (P = 0.99 for vertebral and 0.88 for @entity174 ). @entity561 produced positive effects on the percentage change in bone density, which increased with both dose and time. After 3 yr of treatment with 10 mg of @entity561 or more, the pooled estimate of the difference in percentage change between @entity561 and placebo was 7.48% (95% CI 6.12-8.85) for the lumbar spine (2-3 yr), 5.60% (95% CI 4.80-6.39) for the hip (3-4 yr), 2.08% (95% CI 1.53-2.63) for the forearm (2-4 yr), and 2.73% (95% CI 2.27-3.20) for the total body (3 yr). Heterogeneity of the treatment effect of @entity561 was not consistently explained by any of our a priori hypotheses; in particular, the effect was very similar in prevention and treatment studies. The pooled RR for discontinuing medication due to adverse effects for 5 mg or greater of @entity561 was 1.15 (95% CI 0.93-1.42). The pooled RR for discontinuing medication due to gastro-intestinal (GI) side effects for 5 mg or greater was 1.03 (0.81-1.30, P = 0.83), and the pooled RR for GI adverse effects with continuation of medication was 1.03 (0.98 to 1.07) P = 0.23. CONCLUSIONS: @entity561 increases bone density in both early postmenopausal @entity1 and those with established @entity170 while reducing the rate of @entity174 over 2-3 yr of treatment. Reductions in @entity174 are evident among postmenopausal @entity1 without prevalent @entity174 and have bone mineral density (BMD) levels below the World Health Organization threshold for @entity170 . The impact on @entity174 appears consistent across all fracture types, casting doubt on traditional distinctions between @entity3604 and @entity174 .
