Jie Liu1, Hong-xin Zhang, Xiong-xiong Lu, Jia-jia Hu, Lian-fu Deng. 1. 1 Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases with Integrated Chinese-Western Medicine, Shanghai Institute of Orthopedics and Traumatology, Department of Orthopedics, Shanghai Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai, China .
Abstract
OBJECTIVE: This study carried out sensitivity analysis and trim-fill analysis between bisphosphonates and subtrochanteric, femoral shaft, and atypical femur fracture. METHODS: A random-effects model was used finally. Sensitivity, trim and fill, and publication bias analyses were done. RESULTS: Under a random-effects model (I(2)=87.535), the Z-value=5.672, p-value of test of null<0.001. Bisphosphonate exposure was associated with an increased risk of atypical femur fracture (3.243 [95% CI 2.160-4.870]). When any study is removed, the remaining sensitivity analysis results are still significant. Trim and fill results show that two studies were missed. After filling them, a funnel plot of precision by log risk ratio was more symmetrical. CONCLUSION: This study suggests that (1) there is an increased risk of subtrochanteric, femoral shaft, and atypical femur fracture in bisphosphonate users; (2) any single study does not influence the total sensitivity; (3) two studies have been lost, theoretically.
OBJECTIVE: This study carried out sensitivity analysis and trim-fill analysis between bisphosphonates and subtrochanteric, femoral shaft, and atypical femur fracture. METHODS: A random-effects model was used finally. Sensitivity, trim and fill, and publication bias analyses were done. RESULTS: Under a random-effects model (I(2)=87.535), the Z-value=5.672, p-value of test of null<0.001. Bisphosphonate exposure was associated with an increased risk of atypical femur fracture (3.243 [95% CI 2.160-4.870]). When any study is removed, the remaining sensitivity analysis results are still significant. Trim and fill results show that two studies were missed. After filling them, a funnel plot of precision by log risk ratio was more symmetrical. CONCLUSION: This study suggests that (1) there is an increased risk of subtrochanteric, femoral shaft, and atypical femur fracture in bisphosphonate users; (2) any single study does not influence the total sensitivity; (3) two studies have been lost, theoretically.
Authors: Adrianne C Feldstein; Dennis Black; Nancy Perrin; A Gabriela Rosales; Darin Friess; David Boardman; Richard Dell; Arthur Santora; Julie M Chandler; Mary M Rix; Eric Orwoll Journal: J Bone Miner Res Date: 2012-05 Impact factor: 6.741
Authors: Laura Y Park-Wyllie; Muhammad M Mamdani; David N Juurlink; Gillian A Hawker; Nadia Gunraj; Peter C Austin; Daniel B Whelan; Peter J Weiler; Andreas Laupacis Journal: JAMA Date: 2011-02-23 Impact factor: 56.272
Authors: Seo Young Kim; Sebastian Schneeweiss; Jeffrey N Katz; Raisa Levin; Daniel H Solomon Journal: J Bone Miner Res Date: 2011-05 Impact factor: 6.741