Abstract | OBJECTIVE: DATA SOURCES: Electronic databases, scanning reference lists, and consultation with experts and pharmaceutical companies. Foreign language papers were included. STUDY SELECTION: Included trials were randomised controlled trials of patients with malignant disease and bone metastases who were treated with oral or intravenous bisphosphonate compared with another bisphosphonate, placebo, or standard care. All trials measured at least one outcome of skeletal morbidity. RESULTS: 95 articles were identified; 30 studies fulfilled inclusion criteria. In studies that lasted > or = 6 months, compared with placebo bisphosphonates significantly reduced the odds ratio for fractures (vertebral 0.69, 95% confidence interval 0.57 to 0.84, P < 0.0001; non-vertebral 0.65, 0.54 to 0.79, P < 0.0001; combined 0.65, 0.55 to 0.78, P < 0.0001), radiotherapy (0.67, 0.57 to 0.79, P < 0.0001), and hypercalcaemia (0.54, 0.36 to 0.81, P = 0.003) but not for orthopaedic surgery (0.70, 0.46 to 1.05, P = 0.086) or spinal cord compression (0.71, 0.47 to 1.08, P = 0.113). The reduction in orthopaedic surgery was significant in studies that lasted over a year (0.59, 0.39 to 0.88, P = 0.009). Use of bisphosphonates significantly increased time to first skeletal related event but did not increase survival. Subanalyses showed that most evidence supports use of intravenous aminobisphosphonates. CONCLUSIONS:
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Authors | J R Ross, Y Saunders, P M Edmonds, S Patel, K E Broadley, S R D Johnston |
Journal | BMJ (Clinical research ed.)
(BMJ)
Vol. 327
Issue 7413
Pg. 469
(Aug 30 2003)
ISSN: 1756-1833 [Electronic] England |
PMID | 12946966
(Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)
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Chemical References |
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Topics |
- Bone Neoplasms
(drug therapy, secondary)
- Diphosphonates
(therapeutic use)
- Humans
- Hypercalcemia
(etiology)
- Randomized Controlled Trials as Topic
- Spinal Cord Compression
(prevention & control)
- Spinal Fractures
(prevention & control)
- Survival Analysis
- Treatment Outcome
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