Pharmacological therapies for the prevention of fractures in men

Publisher Copyright: Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To determine the benefits and harms of bisphosphonates, parathyroid or parathyroid-related protein analogues, denosumab, and romosozumab therapy for the primary and secondary prevention of fractures in men.Peer reviewe

Surgical versus conservative interventions for treating fractures of the middle third of the clavicle

BackgroundClavicle fractures are common, accounting for 2.6% to 4% of all fractures. Eighty per cent of clavicle fractures are located in the middle third of the clavicle. Although treatment of these fractures is usually non-surgical, displaced clavicle fractures may be considered for surgical treatment because of their greater risk of non-union.ObjectivesTo assess the effects (benefits and harms) of surgical versus conservative interventions for treating middle third clavicle fractures.Search methodsWe searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (to December 2012), Cochrane Central Register of Controlled Trials (CENTRAL; in the Cochrane Library 2012, Issue 11), MEDLINE (1966 to December 2012), EMBASE (1980 to 2012 Week 40), LILACS (1982 to December 2012), and trial registries (December 2012). No language or publication restrictions were applied.Selection criteriaRandomised and quasi-randomised controlled trials evaluating surgical versus conservative interventions for treating middle third of the clavicle fractures were considered. the primary outcomes were shoulder function or disability, pain and treatment failure (defined as the number of participants who had been given a non-routine secondary surgical intervention (excluding hardware removal) for symptomatic non-union, malunion or other complications).Data collection and analysisAt least two review authors selected eligible trials, independently assessed risk of bias and cross-checked data. Where appropriate, results of comparable trials were pooled.Main resultsWe included eight trials involving 555 participants with middle third clavicle fractures. Four studies compared plate fixation with wearing a sling and four studies compared intramedullary fixation with wearing either a sling or a figure-of-eight bandage. Almost all trials had design features that carry a high risk of bias, thus limiting the strength of their findings.Low-quality evidence from seven trials (429 participants) showed that, compared with conservative treatment, surgical treatment of acute middle third clavicle fractures may not result in a significant improvement in upper arm function at one year of more follow-up: standardised mean difference 0.46, 95% confidence interval (CI) CI -0.06 to 0.98. This corresponds to an absolute mean improvement of 3.2 points in favour of surgery (0.4 points worse to 7 points improvement) on the 100-point Constant score; this is neither clinically nor statistically significant. Low-quality evidence from seven trials (437 participants) indicates a marginal difference in the incidence of treatment failure between surgery (9/232, 3.9%) and conservative treatment (24/205, 11.7%) (risk ratio 0.38, 95% CI 0.15 to 0.99). However, this was dominated by the results of the largest trial, which had an unusually high number of symptomatic malunions in the conservative treatment group. One trial providing pain results at one-year follow-up found no difference between the two groups. No trials reported on quality of life.No significant difference between groups was noted in the pooled results for adverse events but separate analyses by type of adverse events showed that wound infection and/or dehiscence (data from three trials) and secondary surgery due to hardware complications (data from five trials) occurred only in the surgical group. Skin and nerve problems were also more common after surgical treatment, although the difference between the two groups was not statistically significant (data from four trials). Conversely, stiffness or restriction of shoulder movement was more common after conservative treatment (data from three trials).Authors' conclusionsLimited evidence is available from randomised controlled trials on the relative effectiveness of surgical versus conservative treatment for acute middle third clavicle fractures. Treatment options must be chosen on an individual patient basis, after careful consideration of the relative benefits and harms of each intervention and of patient preferences.Universidade Federal de São Paulo, BrazilMonash University, AustraliaUniversidade Federal de São Paulo, Dept Orthopaed & Traumatol, BR-04038032 São Paulo, BrazilMonash Univ, Sch Publ Hlth & Prevent Med, Dept Epidemiol & Prevent Med, Monash Dept Clin Epidemiol,Cabrini Hosp, Malvern, AustraliaUniversidade Federal de São Paulo, Dept Orthopaed & Traumatol, BR-04038032 São Paulo, BrazilWeb of Scienc

Updated method guidelines for cochrane musculoskeletal group systematic reviews and metaanalyses.

The Cochrane Musculoskeletal Group (CMSG), one of 53 groups of the not-for-profit, international Cochrane Collaboration, prepares, maintains, and disseminates systematic reviews of treatments for musculoskeletal diseases. It is important that authors conducting CMSG reviews and the readers of our reviews be aware of and use updated, state-of-the-art systematic review methodology. One hundred sixty reviews have been published. Previous method guidelines for systematic reviews of interventions in the musculoskeletal field published in 2006 have been substantially updated to incorporate methodological advances that are mandatory or highly desirable in Cochrane reviews and knowledge translation advances. The methodological advances include new guidance on searching, new risk-of-bias assessment, grading the quality of the evidence, the new Summary of Findings table, and comparative effectiveness using network metaanalysis. Method guidelines specific to musculoskeletal disorders are provided by CMSG editors for various aspects of undertaking a systematic review. These method guidelines will help improve the quality of reporting and ensure high standards of conduct as well as consistency across CMSG reviews