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Efficacy and safety of elcatonin in postmenopausal women with osteoporosis: a systematic review with network meta-analysis of randomized clinical trials

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Abstract

Summary

The present systematic review aimed to evaluate bone mineral density (BMD) change and complication rates of elcatonin on treating postmenopausal osteoporosis. The result confirmed efficacy of elcatonin and safety in combination therapies of elcatonin (C-E).

Introduction

Postmenopausal osteoporosis is an important issue in global aging trends. One treatment of osteoporosis is elcatonin, a kind of calcitonin. However, it has been challenged for long time because of safety. Many trials investigated on this topic, but they were designed differently. Those designs can be categorized in monotherapy of elcatonin (M-E) and C-E. Unfortunately, no synthesized evidence dealt this topic.

Methods

This study systematically identified target trials from six important databases and only included randomized controlled trial for synthesis. Two investigators assessed quality of eligible trials using the Cochrane Risk of Bias Tool, and they independently extracted data. Network meta-analysis performed Peto odds ratio (POR, used for dealing with zero cell) or weighted mean difference (WMD, for continuous data) with 95% confidence intervals (CI) and consistency H.

Results

Sixteen trials recruiting 2754 women with postmenopausal osteoporosis were included in our study. Elcatonin therapies and non-elcatonin medications had comparable fracture rates and bone mineral density change. Yet, C-E (WMD, − 18.93; 95% CI, − 23.97 to − 13.89) and M-E (WMD, − 13.72; 95% CI, − 19.51 to − 7.94) had significantly lower pain score than non-elcatonin medications. However, M-E (POR = 8.413, 95% CI, 2.031 to 34.859) and non-elcatonin medication (Peto OR, 7.450; 95% CI, 1.479 to 37.530) had significantly higher complication rates than placebo. No evidence detected inconsistency and small study effect in this network model.

Conclusions

Based on current evidence, C-E may be considered for treating postmenopausal osteoporosis because it benefits on pain relief and complications. Moreover, it shows comparable fracture rate and bone mineral density change as compared with anti-osteoporosis and calcium supplements. Nevertheless, further trials are needed to investigate formula and dosages of elcatonin.

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Abbreviations

BMD:

Bone mineral density

CI:

Confidence interval

C-E:

Combination therapy of elcatonin

LFK:

Luis Furuya-Kanamori

M-E:

Monotherapy of elcatonin

POR:

Peto odds ratio

RCT:

Randomized clinical trial

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Authors and Affiliations

  1. Department of Education, Center for Evidence-Based Medicine, Taipei Medical University Hospital, 252, Wu-Hsing Street, Taipei, 110, Taiwan, Republic of China

    W.-C. Chen & Y.-N. Kang

  2. School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, Republic of China

    W.-C. Chen

  3. Division of Neurosurgery, Department of Surgery, Taiwan Adventist Hospital, Taipei, Taiwan, Republic of China

    E.-Y. Lin

  4. Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, Republic of China

    Y.-N. Kang

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  1. W.-C. Chen
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Correspondence to Y.-N. Kang.

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Chen, WC., Lin, EY. & Kang, YN. Efficacy and safety of elcatonin in postmenopausal women with osteoporosis: a systematic review with network meta-analysis of randomized clinical trials. Osteoporos Int 30, 1723–1732 (2019). https://doi.org/10.1007/s00198-019-04997-6

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