VI. Meta-analysis of calcitonin for the treatment of postmenopausal osteoporosis

Ann Cranney, Peter Tugwell, Nicole Zytaruk, Vivian Robinson, Bruce Weaver, Beverley Shea, George Wells, Jonathan Adachi, Lisa Waldegger, Gordon Guyatt, Lauren Griffith, Jessie McGowan, Andrew Willan, Clifford J. Rosen, John P. Bilezikian, Dennis M. Black, Murray J. Favus, Lorraine A. Fitzpatrick, Douglas P. Kiel, Robert MarcusEric Orwoll, Thomas J. Schnitzer

Research output: Contribution to journalArticle

125 Citations (Scopus)

Abstract

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 We contacted osteoporosis investigators to identify additional studies and primary authors for unpublished data.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.

Original languageEnglish (US)
Pages (from-to)540-551
Number of pages12
JournalEndocrine Reviews
Volume23
Issue number4
DOIs
StatePublished - Aug 2002
Externally publishedYes

Fingerprint

Postmenopausal Osteoporosis
Calcitonin
Meta-Analysis
Bone Density
Confidence Intervals
Spine
Bone Fractures
Forearm
Osteoporosis
Therapeutics
Publication Bias
Information Storage and Retrieval
Femur Neck
Incidence
Vitamin D
MEDLINE
Randomized Controlled Trials
Placebos
Research Personnel
Calcium

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism

Cite this

Cranney, A., Tugwell, P., Zytaruk, N., Robinson, V., Weaver, B., Shea, B., ... Schnitzer, T. J. (2002). VI. Meta-analysis of calcitonin for the treatment of postmenopausal osteoporosis. Endocrine Reviews, 23(4), 540-551. https://doi.org/10.1210/er.2001-6002

VI. Meta-analysis of calcitonin for the treatment of postmenopausal osteoporosis. / Cranney, Ann; Tugwell, Peter; Zytaruk, Nicole; Robinson, Vivian; Weaver, Bruce; Shea, Beverley; Wells, George; Adachi, Jonathan; Waldegger, Lisa; Guyatt, Gordon; Griffith, Lauren; McGowan, Jessie; Willan, Andrew; Rosen, Clifford J.; Bilezikian, John P.; Black, Dennis M.; Favus, Murray J.; Fitzpatrick, Lorraine A.; Kiel, Douglas P.; Marcus, Robert; Orwoll, Eric; Schnitzer, Thomas J.

In: Endocrine Reviews, Vol. 23, No. 4, 08.2002, p. 540-551.

Research output: Contribution to journalArticle

Cranney, A, Tugwell, P, Zytaruk, N, Robinson, V, Weaver, B, Shea, B, Wells, G, Adachi, J, Waldegger, L, Guyatt, G, Griffith, L, McGowan, J, Willan, A, Rosen, CJ, Bilezikian, JP, Black, DM, Favus, MJ, Fitzpatrick, LA, Kiel, DP, Marcus, R, Orwoll, E & Schnitzer, TJ 2002, 'VI. Meta-analysis of calcitonin for the treatment of postmenopausal osteoporosis', Endocrine Reviews, vol. 23, no. 4, pp. 540-551. https://doi.org/10.1210/er.2001-6002
Cranney A, Tugwell P, Zytaruk N, Robinson V, Weaver B, Shea B et al. VI. Meta-analysis of calcitonin for the treatment of postmenopausal osteoporosis. Endocrine Reviews. 2002 Aug;23(4):540-551. https://doi.org/10.1210/er.2001-6002
Cranney, Ann ; Tugwell, Peter ; Zytaruk, Nicole ; Robinson, Vivian ; Weaver, Bruce ; Shea, Beverley ; Wells, George ; Adachi, Jonathan ; Waldegger, Lisa ; Guyatt, Gordon ; Griffith, Lauren ; McGowan, Jessie ; Willan, Andrew ; Rosen, Clifford J. ; Bilezikian, John P. ; Black, Dennis M. ; Favus, Murray J. ; Fitzpatrick, Lorraine A. ; Kiel, Douglas P. ; Marcus, Robert ; Orwoll, Eric ; Schnitzer, Thomas J. / VI. Meta-analysis of calcitonin for the treatment of postmenopausal osteoporosis. In: Endocrine Reviews. 2002 ; Vol. 23, No. 4. pp. 540-551.
@article{a497064ade864fc6aef8dfa2763ec43c,
title = "VI. Meta-analysis of calcitonin for the treatment of postmenopausal osteoporosis",
abstract = "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.",
author = "Ann Cranney and Peter Tugwell and Nicole Zytaruk and Vivian Robinson and Bruce Weaver and Beverley Shea and George Wells and Jonathan Adachi and Lisa Waldegger and Gordon Guyatt and Lauren Griffith and Jessie McGowan and Andrew Willan and Rosen, {Clifford J.} and Bilezikian, {John P.} and Black, {Dennis M.} and Favus, {Murray J.} and Fitzpatrick, {Lorraine A.} and Kiel, {Douglas P.} and Robert Marcus and Eric Orwoll and Schnitzer, {Thomas J.}",
year = "2002",
month = "8",
doi = "10.1210/er.2001-6002",
language = "English (US)",
volume = "23",
pages = "540--551",
journal = "Endocrine Reviews",
issn = "0163-769X",
publisher = "The Endocrine Society",
number = "4",

}

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

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 - Article

C2 - 12202469

AN - SCOPUS:0036679570

VL - 23

SP - 540

EP - 551

JO - Endocrine Reviews

JF - Endocrine Reviews

SN - 0163-769X

IS - 4

ER -