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The aim of this study was to perform a head-to-head comparison of efficacy and safety profile between 60 mg denosumab (Den) subcutaneously (SC) per 6 months (Q6M) and 70 mg alendronate (Aln) orally per week (QW) for postmenopausal women with low bone mineral density.We searched electronic databases comparing efficacy and safety of Den SC Q6M and Aln QW in postmenopausal women.The primary outcomes of efficacy evaluation in included trials were incidence of clinical fracture in both groups and bone mineral density (BMD) at different skeletal sites.And adverse events (AEs),including incidence of neoplasms and infections,were considered as secondary outcomes.Following the instructions of Cochrane Handbook for systematic Reviews of Interventions 5.0.2,we identified eligible studies,evaluated the methodological quality and abstracted relevant data.Four heterogeneous randomised controlled trials (RCTs) involving 1942 women were identified.