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

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Abstract

Background

Recently risedronate is suggested to be effective for the prevention and treatment of for osteoporosis in total hip arthroplasty. This meta-analysis aimes to evaluate the efficacy of risedronate in reducing femoral periprosthetic bone mineral density loss in patients undergoing primary total hip arthroplasty.

Methods

A systematic search was performed in Medline (1966-31 October 2017), PubMed (1966-31 October 2017), Embase (1980-31 October 2017), ScienceDirect (1985-31 October 2017) and the Cochrane Library. Only randomized controlled trial (RCT) were included. Fixed/random effect model was used according to the heterogeneity tested by I2 statistic. Meta-analysis was performed using Stata 11.0 software. The outcome measures included periprosthetic bone mineral density, length of stay and adverse effects.

Results

Four RCTs including 198 patients met the inclusion criteria. The present meta-analysis showed that there were significant differences between treatment groups in terms of periprosthetic bone mineral density in Gruen zones 1 (standard mean difference (SMD) = 0.758, 95% CI 0.469 to 1.047, P = 0.000), 2 (SMD = 0.814, 95% CI 0.523 to 1.106, P = 0.000), 3 (SMD = 0.340, 95% CI 0.059 to 0.622, P = 0.018), 6 (SMD = 2.400, 95% CI 2.029 to 2.771, P = 0.000), and 7 (SMD = 2.400, 95% CI 2.029 to 2.771, P = 0.000).

Conclusion

Oral risedronate could significantly reduce periprosthetic bone resorption around an uncemented femoral stem (Gruen zones 1, 2, 3, 6, and 7) up to 6 months after THA. In addition, no severe adverse events were identified. Future trials of risedronate treatment after THA should focus on clinically relevant end points such as the risks of fracture and revision arthroplasty.

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Most cited references 24

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Bilateral low-energy simultaneous or sequential femoral fractures in patients on long-term alendronate therapy.

Nirmal Tejwani, Craig M Capeci (2009)

While alendronate therapy has been shown to decrease the risk of vertebral and femoral neck fractures in postmenopausal osteoporotic patients, recent reports have associated long-term alendronate therapy with unilateral low-energy subtrochanteric and diaphyseal femoral fractures in a small number of patients. To our knowledge, there has been only one report of sequential bilateral femoral fractures in patients on long-term bisphosphonate therapy. We retrospectively reviewed the case log of the senior author over the last four years to identify patients who presented with a subtrochanteric or diaphyseal femoral fracture after a low-energy mechanism of injury (a fall from standing height or less) and who had been taking alendronate for more than five years. Radiographs were reviewed, and the fracture patterns were recorded. Serum calcium levels were recorded when available. Seven patients who sustained low-energy bilateral subtrochanteric or diaphyseal femoral fractures while on long-term alendronate therapy were identified. One patient presented with simultaneous bilateral diaphyseal fractures, two patients had sequential subtrochanteric fractures, and four patients had impending contralateral subtrochanteric stress fractures noted at the time of the initial fracture. Of the latter four, one patient had a fracture through the stress site and the other three patients had prophylactic stabilization of the site with internal fixation. No patient had discontinued alendronate therapy prior to the second fracture. All patients were women with an average age of sixty-one years, and they had been on alendronate therapy for an average of 8.6 years. All fractures were treated with reamed intramedullary nailing and went on to union at an average of four months. In patients on long-term alendronate therapy who present with a subtrochanteric or diaphyseal femoral fracture, we recommend radiographs of the contralateral femur and consideration of discontinuing alendronate in consultation with an endocrinologist. If a contralateral stress fracture is found, prophylactic fixation should be considered.

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The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty.

J D Bobyn, C Anderson Engh (1988)

The influence of stem size and extent of porous coating on femoral bone resorption was examined in 411 cases of primary cementless hip arthroplasty. Moore design, cobalt alloy femoral implants with powder-made sintered porous coating on either one-third, two-thirds, or the full implant length were compared radiographically two years after surgery. A semiquantitative method was adopted for assessing resorption that involved dividing the anteroposterior (AP) and lateral roentgenograms into a total of 16 discrete sites. The 16 sites were qualitatively examined for evidence of resorption by either thinning or darkening of bone relative to the time immediately following surgery. Based on the number of sites that demonstrated resorption, the bone loss was classified as either minor and not likely to cause problems (0 to 4 sites) or pronounced and of potentially harmful clinical consequence (5 or more sites). Pronounced resorption occurred in 18% of the 411 cases. The use of larger stems resulted in increased occurrence of marked bone resorption: stems greater than or equal to 13.5 mm in diameter showed five times the incidence of pronounced resorption compared with stems less than or equal to 12.0 mm in diameter. Stems with two-thirds and full porous coating resulted in a twofold to fourfold increase in the incidence of pronounced bone resorption. The theoretic degree of stress shielding of the femoral shaft in bending was calculated for cases with complete canal filling and a radiographic appearance of bone ingrowth. There was a strong correlation between this theoretic factor and the observed bone resorption.

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Antifracture efficacy and reduction of mortality in relation to timing of the first dose of zoledronic acid after hip fracture.

Steven Boonen, J Magaziner, Jonathan D. Adachi … (2009)

Annual infusions of zoledronic acid (5 mg) significantly reduced the risk of vertebral, hip, and nonvertebral fractures in a study of postmenopausal women with osteoporosis and significantly reduced clinical fractures and all-cause mortality in another study of women and men who had recently undergone surgical repair of hip fracture. In this analysis, we examined whether timing of the first infusion of zoledronic acid study drug after hip fracture repair influenced the antifracture efficacy and mortality benefit observed in the study. A total of 2127 patients (1065 on active treatment and 1062 on placebo; mean age, 75 yr; 76% women and 24% men) were administered zoledronic acid or placebo within 90 days after surgical repair of an osteoporotic hip fracture and annually thereafter, with a median follow-up time of 1.9 yr. Median time to first dose after the incident hip fracture surgery was approximately 6 wk. Posthoc analyses were performed by dividing the study population into 2-wk intervals (calculated from time of first infusion in relation to surgical repair) to examine effects on BMD, fracture, and mortality. Analysis by 2-wk intervals showed a significant total hip BMD response and a consistent reduction of overall clinical fractures and mortality in patients receiving the first dose 2-wk or later after surgical repair. Clinical fracture subgroups (vertebral, nonvertebral, and hip) were also reduced, albeit with more variation and 95% CIs crossing 1 at most time points. We concluded that administration of zoledronic acid to patients suffering a low-trauma hip fracture 2 wk or later after surgical repair increases hip BMD, induces significant reductions in the risk of subsequent clinical vertebral, nonvertebral, and hip fractures, and reduces mortality.

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Author and article information

Contributors

Liqing Yang: yanglq@sj-hospital.org

Journal

Journal ID (nlm-ta): J Orthop Surg Res

Journal ID (iso-abbrev): J Orthop Surg Res

Title: Journal of Orthopaedic Surgery and Research

Publisher: BioMed Central (London )

ISSN (Electronic): 1749-799X

Publication date (Electronic): 17 April 2018

Publication date PMC-release: 17 April 2018

Publication date Collection: 2018

Volume: 13

Electronic Location Identifier: 88

Affiliations

ISNI 0000 0004 1806 3501, GRID grid.412467.2, Department of Orthopedics, , Shengjing Hospital of China Medical University, ; Shenyang, 110004 China

Article

Publisher ID: 808

DOI: 10.1186/s13018-018-0808-z

PMC ID: 5904972

PubMed ID: 29665839

SO-VID: 5db37e78-a4cc-42a2-b696-f7ef4d6d5a81

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 19 October 2017

Date accepted : 6 April 2018

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ScienceOpen disciplines: Surgery

Keywords: risedronate,total hip arthroplasty,bone mineral density,meta-analysis

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ScienceOpen disciplines: Surgery

Keywords: risedronate, total hip arthroplasty, bone mineral density, meta-analysis

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

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Most cited references 24

Bilateral low-energy simultaneous or sequential femoral fractures in patients on long-term alendronate therapy.

The influence of stem size and extent of porous coating on femoral bone resorption after primary cementless hip arthroplasty.

Antifracture efficacy and reduction of mortality in relation to timing of the first dose of zoledronic acid after hip fracture.

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