Effect of bisphosphonates in preventing femoral periprosthetic bone resorption after primary cementless total hip arthroplasty: a meta-analysis

Abstract

BackgroundBone loss leading to aseptic loosening of the prosthesis and periprosthetic fracture is a mode of failure in cementless total hip arthroplasty (THA). The aim of this meta-analysis was to evaluate the effect of bisphosphonates in preventing femoral periprosthetic bone resorption following primary cementless THA zone by zone.MethodClinical randomized controlled trials concerning bisphosphonates application after primary cementless THA published up to October 2014 were retrieved from PubMed, Cochrane library, and Embase databases. The methodological quality of the included studies was assessed by the Physiotherapy Evidence Database (PEDro) scale. Data analysis was performed using StataSE12.0.ResultsTen randomized controlled trials involving a total of 502 patients were assessed; the bisphosphonates group included 256 patients and the control group included 246 patients. The meta-analysis showed that the bone mineral density (BMD) of most femoral periprosthetic zones in bisphosphonates group was significantly higher than that in the control group at 3 months postoperatively except zone 5 with no significant difference. At 6 and 12 months, the BMD of bisphosphonates group was much higher than that in control group except zone 5, which showed no statistical difference. The BMD of bisphosphonates group was persistently higher than control group in zone 6 and 7 at 5 years postoperatively, while the other zones had no significant difference. Both serum bone alkaline phosphatase and urinary type I collagen N-telopeptide were significantly suppressed by bisphosphonates at 3, 6, and 12 months.ConclusionBisphosphonates seem to decrease early femoral periprosthetic bone resorption after primary cementless THA. Drug efficacy was found to be long-standing in the main load-bearing zones.

Oral risedronate increases Gruen zone bone mineral density after primary total hip arthroplasty: a meta-analysis

“…Thus, we could not conclude that risedronate had a significant influence on bone loss among patients with only THA. Zhao et al [ 1 ] conducted a similar meta-analysis about bisphosphonates for bone loss after THA; however, only one study comparing risedronate versus placebo was included in the meta-analysis. Therefore, large-scale trials are required to validate the effects of risedronate focus on patients with THA.…”

“…Total hip arthroplasty (THA) has become a popular and successful surgical option for patients with hip osteoarthritis or hip fracture [ 1 ]. Some studies revealed that more than 75% of the revision arthroplasties were performed due to prosthesis loosening and peri-prosthetic fracture, which were accompanied by severe periprosthetic bone loss [ 2 ].…”

Effects of bisphosphonates in preventing periprosthetic bone loss following total hip arthroplasty: a systematic review and meta-analysis

“…Some studies indicated that BPs had no significant effect on suppressing bone loss after THA [12, 13]. In contrast, previous meta-analyses suggested BPs could inhibit early bone resorption around the implant [14–17]. However, these studies only included randomized controlled trials (RCTs) published before 2011.…”

The efficiency of risedronate in reducing bone resorption after total hip arthroplasty: a meta-analysis of randomized control trials at a minimum of 6 months’ follow-up

“…Bisphosphonates are antiresorptive agent which promotes bone mineralization and inhibits the biological effect of osteoclasts [ 8 ]. Substantial randomized controlled trials (RCTs) have demonstrated its beneficial effect on preserving periprosthetic bone in cementless THA [ 9 ]. Risedronate is a bisphosphonate with potent antiresorptive activity that is used in the treatment of Paget disease of bone and multiple myeloma [ 10 , 11 ].…”