Objective To explore whether bone turnover biomarkers (BTMs), i.e., C-terminal telopeptide of type I collagen (CTX) and procollagen type I aminoterminal propeptide (PINP), are associated with fracture. Methods We searched electronic database including PubMed, Embase and Cochrane Library, and the reference lists of relevant articles published from inception to August 22, 2018. An updated meta-analysis was performed to assess the prediction value of CTX and PINP in fracture. Results Nine articles met our inclusion criteria and were included in the meta-analysis. The crude and adjusted effect size between PINP and fracture were extracted from two and five studies, respectively. PINP was not associated with fracture incidence without adjusting covariates (crude GR, 1.03; 95% CI, 0.91–1.17). After adjusting for potential confounders, PINP demonstrated a significant positive association with fracture (adjusted GR, 1.28; 95% CI, 1.15–1.42). In the subgroup analysis of studies after adjusting covariates, there were significant associations in women. Both the crude (1.16, 95%CI, 1.04–1.20) and adjusted GR (1.20, 95%CI, 1.05–1.37) shown positive relationships between CTX and fracture, which were extracted from four and six studies, separately. The sensitivity analysis confirmed the stability of the results. In the subgroup analysis of studies after adjusting covariates, there were significant associations in the subgroups of elderly, female, and hip fracture patients. Conclusions Our results indicate a statistically significant but modest association between BTMs (s-PINP or s-CTX) and future fracture risk after adjusting for BMD and clinical risk factors. The causal relationship between the two clinical conditions requires future validation with more standardized studies. Registration number CRD42018107879 Electronic supplementary material The online version of this article (10.1186/s13018-019-1100-6) contains supplementary material, which is available to authorized users.

To evaluate the efficacy and safety of bipolar sealer for the reduction of intraoperative blood loss and transfusion requirements for patients undergoing major orthopedic surgery, including total knee arthroplasty (TKA), total hip arthroplasty (THA), and spinal surgery. and hemoglobin drop (WMD, -0.14; 95% CI, -0.27-0.00; P = 0.05). There were no significant differences between operation time, the length of the hospital stay and the occurrence of infection (P > 0.05). Compared to standard electrocautery, bipolar sealer can effectively reduce intraoperative blood loss and subsequent blood transfusion without increasing the rate of infections.