Benefits and harms of non-surgical and non-pharmacological management of osteoporotic vertebral fractures: A systematic review and meta-analysis

Background: Some patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported to exhibit neurological symptoms such as seizures and impaired consciousness. Our study reviews reported cases to assess the pharmacological approach to managing seizures in SARS-CoV-2 patients and associated outcomes. Methods: A systematic review of case reports on the incidence of seizures following coronavirus disease 2019 (COVID-19) among patients that reported use of antiepileptic drugs (AEDs) in management was performed by using the PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines. Databases used included EMBASE, PubMed, SCOPUS, and Google Scholar. Data was presented as qualitative and descriptive data. Results: In total, 67 articles were selected for full-text assessment, of which 19 were included in the final review. Patients had a median age of 54 years, most of whom were male. Remdisivir, dexamethasone, Laminavir, hydroxychloroquine, azithromycin, and Lopinavir-ritonavir were common agents used in the management of COVID-19. Most patients presented with either generalized tonic-clonic seizures or status epilepticus. Most patients received levetiracetam as drug choice or as part of their regimen. Other AEDs commonly prescribed included midazolam and sodium valproate. Some patients received no antiepileptic drug therapy. Most of the patients who died had more than one comorbidity. Also, most of the patients who died received COVID-19 treatment drugs. None of the patients who received midazolam as drug choice or as part of their regimen developed recurrent seizures in contrast to patients who received levetiracetam and sodium valproate as drug choice or as part of their regimen. Interestingly, none of the patients who received no AEDs suffered recurrent seizures or died. Conclusions: Standard guidelines for managing seizures in COVID-19 patients may be required. A limitation of this review is that it involved the use of case reports with no controls and a small number of patients.

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The risk of hip and non-vertebral fractures in type 1 and type 2 diabetes: A systematic review and meta-analysis update

Bone ◽

10.1016/j.bone.2020.115457 ◽

2020 ◽

Vol 137 ◽

pp. 115457 ◽

Cited By ~ 1

Author(s):

Tatiane Vilaca ◽

Marian Schini ◽

Susan Harnan ◽

Anthea Sutton ◽

Edith Poku ◽

...

Keyword(s):

Systematic Review ◽

Type 2 Diabetes ◽

Vertebral Fractures ◽

Meta Analysis

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Osteoporotic vertebral fractures: predictive factors for conservative treatment failure. A systematic review

European Spine Journal ◽

10.1007/s00586-017-5340-z ◽

2017 ◽

Vol 27 (10) ◽

pp. 2565-2576 ◽

Cited By ~ 17

Author(s):

Marco Muratore ◽

Andrea Ferrera ◽

Alessandro Masse ◽

Alessandro Bistolfi

Keyword(s):

Systematic Review ◽

Conservative Treatment ◽

Treatment Failure ◽

Predictive Factors ◽

Vertebral Fractures ◽

Osteoporotic Vertebral Fractures

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Pharmacological interventions for the prevention of fetal growth restriction: protocol for a systematic review and network meta-analysis

BMJ Open ◽

10.1136/bmjopen-2019-029467 ◽

2019 ◽

Vol 9 (7) ◽

pp. e029467 ◽

Cited By ~ 2

Author(s):

Alessandra Bettiol ◽

Niccolò Lombardi ◽

Giada Crescioli ◽

Laura Avagliano ◽

Alessandro Mugelli ◽

...

Keyword(s):

Systematic Review ◽

Adverse Events ◽

Fetal Growth ◽

Fetal Growth Restriction ◽

Meta Analysis ◽

Scientific Journal ◽

Antiplatelet Agents ◽

Growth Restriction ◽

Pharmacological Management ◽

Safety Outcome

IntroductionFetal growth restriction (FGR) includes different conditions in which a fetus fails to reach the own full growth, and accounts for 28%–45% of non-anomalous stillbirths. The management of FGR is based on the prolongation of pregnancy long enough for fetal organs to mature while preventing starvation. As for pharmacological management, most guidelines recommend treatment with low-dose aspirin and/or with heparin, although this approach is still controversial and innovative promising therapies are under investigation. As no firm evidence exists to guide clinicians towards the most effective therapeutic intervention, this protocol describes methods for a systematic review and network meta-analysis (NetMA) of pharmacological treatments for FGR prevention.Methods and analysisWe will search MEDLINE and Embase for clinical trials and observational studies performed on gestating women with clinically diagnosed risk of FGR. Experimental interventions will include heparin and low-molecular-weight heparin, acetylsalicylic acid, antiplatelet agents, phosphodiesterase type 3 and 5 inhibitors, maternal vascular endothelial growth factor gene therapy, nanoparticles, microRNA, statins, nitric oxide donors, hydrogen sulphide, proton pump inhibitors, melatonin, creatine and N-acetylcysteine, and insulin-like growth factors, compared between each other or to placebo or no treatment. Primary efficacy outcome is FGR. Secondary efficacy outcomes will be preterm birth, fetal or neonatal death and neonatal complications. For the safety outcome, all adverse events reported in included studies and experienced by either mothers, fetuses or newborns will be considered. Two review authors will independently screen title, abstract and full paper text, and will independently extract data from included studies. Where possible and appropriate, for primary and secondary efficacy outcomes, a NetMA will be performed using a random-effects model within a frequentist framework. Adverse events will be narratively described.Ethics and disseminationResults will be disseminated through a peer-reviewed scientific journal, and by scientific congresses and meetings.PROSPERO registration numberCRD42019122831.

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The Role of Spinal Orthoses in Osteoporotic Vertebral Fractures of the Elderly Population (Age 60 Years or Older): Systematic Review

Global Spine Journal ◽

10.1177/2192568220948036 ◽

2020 ◽

pp. 219256822094803

Author(s):

Barry Ting Sheen Kweh ◽

Hui Qing Lee ◽

Terence Tan ◽

Joost Rutges ◽

Travis Marion ◽

...

Keyword(s):

Systematic Review ◽

Elderly Patients ◽

Vertebral Fractures ◽

Postural Stability ◽

Elderly Population ◽

The Elderly ◽

Functional Improvement ◽

Osteoporotic Vertebral Fractures ◽

Spinal Orthoses

Study Design: Systematic review. Objective: Spinal orthoses have been generally used in the management of osteoporotic vertebral fractures in the elderly population with purported positive biomechanical and functional effects. To our knowledge, this is the first systematic review of the literature examining the role of spinal orthoses in osteoporotic elderly patients who sustain low energy trauma vertebral fractures. Methods: A systematic literature review adherent to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted. Methodical searches utilizing MEDLINE, EMBASE, Google Scholar, and Cochrane Databases was performed. Results: Of the 2019 articles initially retrieved, 7 published articles (4 randomized controlled trials and 3 prospective cohort studies) satisfied the inclusion criteria. Five studies reported improvement in quantitative measurements of spinal column stability when either a rigid or semirigid orthosis was used, while 1 study was equivocal. The studies also showed the translation of biomechanical benefit into significant functional improvement as manifested by improved postural stability and reduced body sway. Subjective improvement in pain scores and quality of life was also noted with bracing. Conclusion: The use of spinal orthoses in neurologically intact elderly patients aged 60 years and older with osteoporotic compression vertebral fractures results in improved biomechanical vertebral stability, reduced kyphotic deformity, enhanced postural stability, greater muscular strength and superior functional outcomes.

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