Bisphosphonates for osteoporosis in people with cystic fibrosis

Louise S. Conwell, Anne B. Chang

    Research output: Contribution to journalReview articleResearchpeer-review

    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.

    Original languageEnglish
    Article numberCD002010
    JournalCochrane Database of Systematic Reviews
    Issue number4
    DOIs
    Publication statusPublished - 2009

    Fingerprint

    Diphosphonates
    Cystic Fibrosis
    Bone Density
    Osteoporosis
    pamidronate
    zoledronic acid
    Bone and Bones
    Pain
    Adrenal Cortex Hormones
    Physiologic Calcification
    Inborn Genetic Diseases
    PubMed
    Femur
    Patient Selection
    Spine
    Randomized Controlled Trials
    Quality of Life
    Research Personnel
    Databases
    Transplants

    Cite this

    @article{5a44a29e317c42a6b8377924642aba0e,
    title = "Bisphosphonates for osteoporosis in people with cystic fibrosis",
    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.",
    keywords = "Bone [prevention & control], Bone density [drug effects], Cystic fibrosis [*complications], Diphosphonates [*therapeutic use], Fractures, Humans, Lung transplantation, Osteoporosis [*drug therapy], Randomized controlled trials as topic",
    author = "Conwell, {Louise S.} and Chang, {Anne B.}",
    year = "2009",
    doi = "10.1002/14651858.CD002010.pub2",
    language = "English",
    journal = "Cochrane database of systematic reviews (Online)",
    issn = "1469-493X",
    publisher = "John Wiley & Sons",
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    }

    Bisphosphonates for osteoporosis in people with cystic fibrosis. / Conwell, Louise S.; Chang, Anne B.

    In: Cochrane Database of Systematic Reviews, No. 4, CD002010, 2009.

    Research output: Contribution to journalReview articleResearchpeer-review

    TY - JOUR

    T1 - Bisphosphonates for osteoporosis in people with cystic fibrosis

    AU - Conwell, Louise S.

    AU - Chang, Anne B.

    PY - 2009

    Y1 - 2009

    N2 - 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.

    AB - 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.

    KW - Bone [prevention & control]

    KW - Bone density [drug effects]

    KW - Cystic fibrosis [complications]

    KW - Diphosphonates [therapeutic use]

    KW - Fractures

    KW - Humans

    KW - Lung transplantation

    KW - Osteoporosis [drug therapy]

    KW - Randomized controlled trials as topic

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    U2 - 10.1002/14651858.CD002010.pub2

    DO - 10.1002/14651858.CD002010.pub2

    M3 - Review article

    JO - Cochrane database of systematic reviews (Online)

    JF - Cochrane database of systematic reviews (Online)

    SN - 1469-493X

    IS - 4

    M1 - CD002010

    ER -