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BACKGROUND: Proton pump inhibitors (PPI) are often used for the clinical treatment of gastroxia, and the long-term use of PPI can lead to osteoporosis. However, their relationship and mechanism are not yet clear. This systematic review aimed to clarify the relationship between the long-term use of PPI and osteoporosis from the perspective of bone mineral density (BMD) and bone metabolism. METHODS: A search of CNKI, CBM, VIP, WanFang, PubMed, Web of Science, EMBASE, and Cochrane Library was performed using the main keywords of “osteoporosis; bone metabolism; proton pump inhibitor; PPI” in Chinese and English, respectively. The search time was from inception until March 1, 2020. Literature about the effect of long-term use of PPI on BMD and bone metabolism were retrieved and strictly assessed for literature quality. Relevant information and data were accurately extracted from the literature. The meta-analysis was performed using RevMan5.3. RESULTS: A total of 9 studies involving 1 236 individuals were included. Meta-analysis results showed that: the BMD of the lumbar L1-4, femoral neck, and proximal femur as well as the overall BMD of the hip joint in the PPI group were significantly lower than those in the control group. Lumbar vertebra BMD: expressed as T value, mean difference (MD)=-0.24, 95% confidence interval (CI):-0.45 to-0.04, P=0.02, and expressed in g/cm², MD=-0.12, 95%CI:-0.22 to -0.03, P=0.010); femoral neck BMD: MD=-0.31, 95%CI: -0.44 to -0.18, P < 0.000 01); proximal femoral BMD: MD=-0.17, 95%CI:-0.20 to-0.14, P < 0.000 01; overall BMD of the hip joint: MD=-0.27, 95%CI: -0.51 to -0.02, P=0.04. The level of osteocalcin in the PPI group was significantly higher than that in the control group (MD=0.23, 95%CI: 0.19-0.27, P < 0.000 01). The level of parathyroid hormone in the PPI group was lower than that in the control group, and the difference was not statistically significant (MD=-0.19, 95%CI: -1.91 to 1.53, P=0.83). In conclusion, the long-term use of PPI can reduce BMD and increase osteocalcin level, which easily lead to osteoporosis but the effects on parathyroid hormone level is yet unknown. Further high-quality studies are required to verify the above conclusions. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Knee arthroscopy has a good effect on mild to moderate knee osteoarthritis, but the lavage fluid will take away a lot of the original synovial fluid. It is still controversial whether synovial fluid can be further improved by postoperative injection of sodium hyaluronate. This study is designed to evaluate the efficacy of arthroscopy combined with sodium hyaluronate compared with arthroscopy alone for knee osteoarthritis. METHODS: The relevant literature was searched from CNKI, Wangfang, VIP, CBM, PubMed, Web of Science, EMBASE, and Cochrane Library from inception to March 27, 2020. The randomized controlled trials on arthroscopy combined with sodium hyaluronate for knee osteoarthritis were included. Included studies were evaluated using the Cochrane system evaluation method. Meta-analysis was performed using RevMan 5.3 software. The primary outcomes included Lequesne score, Lysholm score, WOMAC score, and visual analogue scale score. The secondary outcomes included tumor necrosis factor-α, interleukin-1β, and interleukin-6 in synovial fluid. RESULTS: A total of 31 randomized controlled trials were included with 1 350 cases. Meta-analysis results showed that in primary outcomes: (1) Lequesne score was better in the combined group than that in the control group at 1 week after surgery (MD=-0.33, 95%CI: 0.67 to -0.00, P=0.05), after the full treatment course (MD=-1.00, 95%CI:-1.34 to -0.66, P < 0.000 01), 3 months after surgery (MD=-1.04, 95%CI:-1.44 to -0.64, P < 0.000 01). (2) Lysholm score was better in the combined group than that in the control group at 1 week after surgery (MD=5.84, 95%CI:4.79-6.88, P < 0.000 01), after the full treatment course (MD=9.21, 95%CI:6.93-11.49, P < 0.000 01), 3 months after surgery (MD=9.14, 95%CI:6.34-11.94, P < 0.000 01), half year after surgery (MD=10.14, 95%CI: 6.50-13.78, P < 0.000 01), 1 year after surgery (MD=11.54, 95%CI:9.92-13.16, P < 0.000 01). (3) WOMAC score was better in the combined group than that in the control group at 1 year after surgery (MD=-18.38, 95%CI:-28.53 to -8.23, P=0.000 4). Visual analogue scale score was better in the combined group than that in the control group at 1 week after surgery (MD=-0.91, 95%CI:-1.11 to -0.72, P < 0.000 01), after the full treatment course (MD=-0.97, 95%CI:-1.23 to -0.72, P < 0.000 01), 3 months after surgery (MD=-0.41, 95%CI: -0.52 to -0.31, P < 0.000 01). (4) Lequense score was better in the combined group after the full treatment course compared with that after only one week (MD=1.47, 95%CI: 1.14-1.80, P < 0.000 01). (5) The combined group could better reduce the contents of tumor necrosis factor-α, interleukin-1β, and interleukin-6 in the synovial fluid (P ≤ 0.05), which could better control the inflammation. CONCLUSION: Arthroscopy combined with sodium hyaluronate can achieve a better short- and medium-term curative effect in knee osteoarthritis than arthroscopy alone. However, more high-quality studies are needed to verify the above conclusions. [ABSTRACT FROM AUTHOR]

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