Bisphosphonates for the preservation of periprosthetic bone mineral density after total joint arthroplasty: a meta-analysis of 25 randomized controlled trials

被引:23
作者
Shi, M. [1 ]
Chen, L. [2 ]
Xin, Z. [1 ]
Wang, Y. [1 ]
Wang, W. [1 ]
Yan, S. [1 ]
机构
[1] Zhejiang Univ, Sch Med, Affiliated Hosp 2, Dept Orthopaed Surg, 88 Jiefang Rd, Hangzhou 310009, Zhejiang, Peoples R China
[2] Zhejiang Univ, Sir Run Run Shaw Hosp, Dept Endocrinol & Metab, Sch Med, 3 Qingchun Rd, Hangzhou 310009, Zhejiang, Peoples R China
关键词
Arthroplasty; Bisphosphonates; Bone mineral density; Meta-analysis; TOTAL HIP-ARTHROPLASTY; TOTAL KNEE ARTHROPLASTY; DOUBLE-BLIND; FOLLOW-UP; ALENDRONATE; REPLACEMENT; RISEDRONATE; THERAPY; RISK; OSTEOARTHRITIS;
D O I
10.1007/s00198-018-4488-7
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The present meta-analysis aimed to evaluate the long-term efficacy of bisphosphonates (BPs) on preservation of periprosthetic bone mineral density (BMD) after joint arthroplasty. It confirmed the protective effect of BPs in a long-term follow-up, and found the influence factors on this effect. Periprosthetic bone loss is believed to cause aseptic loosening and failed prosthetic fixation in joint arthroplasty. This meta-analysis which included high-quality randomized controlled trials aimed to analyze the effect of bisphosphonates on maintaining periprosthetic bone mineral density after total joint arthroplasty. Twenty-five RCTs were included and the total number of participants was 1163 by computerized searches of bibliographic databases. The weighted mean differences with 95% confidence interval were calculated to evaluate the efficacy of BPs on total periprosthetic BMD and the BMD of different Gruen zones. Subgroup analyses identified the potentially influencing factors such as surgical site, cement fixation, and generation of BPs. A descriptive review was conducted for BP-related adverse effects. The BPs group presented significantly higher total periprosthetic BMD in the BPs group than that in the control group at 3, 6, 12 months, 2-4 years, and 5-10 years after arthroplasty (P < 0.05). The BPs group presented significantly higher periprosthetic BMD in femoral Gruen Zone 1 and 7 than that in the control group at 3, 6, 12 months, 2-4 years, and 5-10 years (P < 0.05). The heterogeneity was minimized by dividing THA and TKA into two subgroups. Subgroup analyses revealed that the effect of BPs on preservation of BMD was significantly greater in arthroplasty with cemented component than in that with uncemented component at 12 months and 5-10 years (P < 0.05), and the administration of the second and third generation BPs was significantly more effective than the first-generation BPs at 6 and 12 months (P < 0.05). None of the included studies described severe or fatal adverse effects related to BPs. BPs have significantly long-term efficacy on the preservation of periprosthetic BMD after joint arthroplasty. To obtain a better efficacy, the cemented components and the second and third generation BPs are recommended.
引用
收藏
页码:1525 / 1537
页数:13
相关论文
共 45 条
[1]  
[Anonymous], J JIANGSU U MED
[2]  
[Anonymous], PROSPERO INT PROSPEC
[3]   Alendronate prevents femoral periprosthetic bone loss following total hip arthroplasty: Prospective randomized double-blind study [J].
Arabmotlagh, Mohammad ;
Rittmeister, Markus ;
Hennigs, Thorsten .
JOURNAL OF ORTHOPAEDIC RESEARCH, 2006, 24 (07) :1336-1341
[4]   Changes of Femoral Periprosthetic Bone Mineral Density 6 Years after Treatment with Alendronate following Total Hip Arthroplasty [J].
Arabmotlagh, Mohammad ;
Pilz, Mathias ;
Warzecha, Joerg ;
Rauschmann, Michael .
JOURNAL OF ORTHOPAEDIC RESEARCH, 2009, 27 (02) :183-188
[5]  
Atkins D, 2004, BMJ-BRIT MED J, V328, P1490
[6]   Changes in bone mineral density in the proximal femur after cementless total hip arthroplasty - A five-year longitudinal study [J].
Brodner, W ;
Bitzan, P ;
Lomoschitz, F ;
Krepler, P ;
Jankovsky, R ;
Lehr, S ;
Kainberger, F ;
Gottsauner-Wolf, F .
JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 2004, 86B (01) :20-26
[7]   Drugs in development: bisphosphonates and metalloproteinase inhibitors [J].
Catterall, JB ;
Cawston, TE .
ARTHRITIS RESEARCH & THERAPY, 2003, 5 (01) :12-24
[8]   What Host Factors Affect Aseptic Loosening After THA and TKA? [J].
Cherian, Jeffrey J. ;
Jauregui, Julio J. ;
Banerjee, Samik ;
Pierce, Todd ;
Mont, Michael A. .
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, 2015, 473 (08) :2700-2709
[9]   Effect of etidronate in preventing periprosthetic bone loss following cemented hip arthroplasty: A randomized, double blind, controlled trial [J].
Fokter, Samo K. ;
Komadina, Radko ;
Repse-Fokter, Alenka .
WIENER KLINISCHE WOCHENSCHRIFT, 2006, 118 (9-10) :23-28
[10]   Bisphosphonate Use and the Risk of Undergoing Total Knee Arthroplasty in Osteoporotic Patients with Osteoarthritis A Nationwide Cohort Study in Taiwan [J].
Fu, Shau-Huai ;
Wang, Chen-Yu ;
Yang, Rong-Sen ;
Wu, Fe-Lin Lin ;
Hsiao, Fei-Yuan .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 2017, 99 (11) :938-946