TY - JOUR
T1 - VI. Meta-analysis of calcitonin for the treatment of postmenopausal osteoporosis
AU - Cranney, Ann
AU - Tugwell, Peter
AU - Zytaruk, Nicole
AU - Robinson, Vivian
AU - Weaver, Bruce
AU - Shea, Beverley
AU - Wells, George
AU - Adachi, Jonathan
AU - Waldegger, Lisa
AU - Guyatt, Gordon
AU - Griffith, Lauren
AU - McGowan, Jessie
AU - Willan, Andrew
AU - Rosen, Clifford J.
AU - Bilezikian, John P.
AU - Black, Dennis M.
AU - Favus, Murray J.
AU - Fitzpatrick, Lorraine A.
AU - Kiel, Douglas P.
AU - Marcus, Robert
AU - Orwoll, Eric S.
AU - Schnitzer, Thomas J.
PY - 2002/8
Y1 - 2002/8
N2 - Objective: To review the effect of calcitonin on bone density and fractures in postmenopausal women. Data Source: We searched MEDLINE and EMBASE from 1966 to 2000 and examined citations of relevant articles and the proceedings of international osteoporosis meetings. We contacted osteoporosis investigators to identify additional studies and primary authors for unpublished data. Study Selection: We included 30 studies that randomized women to calcitonin or an alternative (placebo or calcium and/or vitamin D) and measured bone density or fracture incidence for at least 1 yr. Data Extraction: For each trial, three independent reviewers assessed the methodological quality and abstracted data. Data Synthesis: Calcitonin reduced the incidence of vertebral fractures, 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 fractures, 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: Calcitonin likely increases bone density in postmenopausal women 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. Calcitonin likely reduces the risk of vertebral fracture; its effect on nonvertebral fracture remains uncertain.
AB - Objective: To review the effect of calcitonin on bone density and fractures in postmenopausal women. Data Source: We searched MEDLINE and EMBASE from 1966 to 2000 and examined citations of relevant articles and the proceedings of international osteoporosis meetings. We contacted osteoporosis investigators to identify additional studies and primary authors for unpublished data. Study Selection: We included 30 studies that randomized women to calcitonin or an alternative (placebo or calcium and/or vitamin D) and measured bone density or fracture incidence for at least 1 yr. Data Extraction: For each trial, three independent reviewers assessed the methodological quality and abstracted data. Data Synthesis: Calcitonin reduced the incidence of vertebral fractures, 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 fractures, 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: Calcitonin likely increases bone density in postmenopausal women 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. Calcitonin likely reduces the risk of vertebral fracture; its effect on nonvertebral fracture remains uncertain.
UR - http://www.scopus.com/inward/record.url?scp=0036679570&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0036679570&partnerID=8YFLogxK
U2 - 10.1210/er.2001-6002
DO - 10.1210/er.2001-6002
M3 - Review article
C2 - 12202469
AN - SCOPUS:0036679570
SN - 0163-769X
VL - 23
SP - 540
EP - 551
JO - Endocrine reviews
JF - Endocrine reviews
IS - 4
ER -