Anti-osteoporotic drug efficacy for periprosthetic bone loss after total hip arthroplasty: A systematic review and network meta-analysis

IF 1.5 4区 医学 Q3 ORTHOPEDICS
Masaki Hatano , Yasuhiko Koizumi , Norio Yamamoto , Kota Miyoshi , Kensuke Kawabata , Takeyuki Tanaka , Sakae Tanaka , Akihiro Shiroshita , Yuki Kataoka
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引用次数: 0

Abstract

Background

Periprosthetic bone loss following total hip arthroplasty (THA) threatens prosthesis stability. This systematic review and network meta-analysis aimed to compare the efficacy of anti-osteoporotic drugs for measures of hip function according to functional outcomes, periprosthetic femoral bone mineral density loss in each Gruen zone, and revision surgery after THA.

Methods

The systematic search of six literature databases was conducted in December 2021 in accordance with PRISMA guidelines. Adult participants who underwent primary THA were included. A random-effects network meta-analysis was performed within a frequentist framework, and the confidence in the evidence for each outcome was evaluated using the CINeMA tool, which assessed the credibility of results from the network meta-analysis. We included 22 randomized controlled trials (1243 participants) comparing the efficacy and safety of bisphosphonates (including etidronate, clodronate, alendronate, risedronate, pamidronate, and zoledronate), denosumab, selective estrogen receptor modulator, teriparatide, calcium + vitamin D, calcium, and vitamin D. We defined the period for revision surgery as the final follow-up period.

Results

Raloxifene, bisphosphonate, calcium + vitamin D, and denosumab for prosthetic hip function might have minimal differences when compared with placebos. The magnitude of the anti-osteoporotic drug effect on periprosthetic femoral bone loss varied across different Gruen zones. Bisphosphonate, denosumab, teriparatide might be more effective than placebo in Gruen zone 1 at 12 months after THA. Additionally, bisphosphonate might be more effective than placebo in Gruen zones 2, 5, 6, and 7 at 12 months after THA. Denosumab was efficacious in preventing bone loss in Gruen zones 6 and 7 at 12 months after THA. Teriparatide was likely to be efficacious in preventing bone loss in Gruen zone 7 at 12 months after THA. Raloxifene was slightly efficacious in preventing bone loss in Gruen zones 2 and 3 at 12 months after THA. Calcium was slightly efficacious in preventing bone loss in Gruen zone 5 at 12 months after THA. None of the studies reported revision surgery.

Conclusions

Bisphosphonate and denosumab may be effective anti-osteoporotic drugs for preventing periprosthetic proximal femoral bone loss due to stress shielding after THA, particularly in cementless proximal fixation stems, which are the most commonly used prostheses worldwide.
抗骨质疏松药物对全髋关节置换术后假体周围骨质流失的疗效:系统综述和网络荟萃分析。
背景:全髋关节置换术(THA)后的假体周围骨质流失威胁着假体的稳定性。本系统综述和网络荟萃分析旨在比较抗骨质疏松药物的疗效,根据功能结果、每个格鲁恩区的假体周围股骨骨矿物质密度损失和全髋关节置换术后翻修手术来衡量髋关节功能:根据 PRISMA 指南,于 2021 年 12 月对六个文献数据库进行了系统检索。纳入了接受初次 THA 的成人参与者。在频数主义框架内进行了随机效应网络荟萃分析,并使用CINeMA工具评估了每项结果的证据可信度,该工具可评估网络荟萃分析结果的可信度。我们纳入了22项随机对照试验(1243名参与者),比较了双膦酸盐(包括依替膦酸盐、氯膦酸盐、阿仑膦酸盐、利塞膦酸盐、帕米膦酸盐和唑来膦酸盐)、地诺单抗、选择性雌激素受体调节剂、特立帕肽、钙+维生素D、钙和维生素D的疗效和安全性:与安慰剂相比,雷洛昔芬、双磷酸盐、钙+维生素D和地诺单抗对假体髋关节功能的作用可能差异很小。抗骨质疏松药物对不同格鲁恩区股骨假体周围骨质流失的影响程度各不相同。在 THA 术后 12 个月时,双膦酸盐、地诺单抗和特立帕肽在格鲁恩 1 区可能比安慰剂更有效。此外,在 THA 后 12 个月,双膦酸盐在格鲁恩区 2、5、6 和 7 可能比安慰剂更有效。在 THA 术后 12 个月时,地诺单抗能有效防止格鲁恩区 6 和 7 的骨质流失。在 THA 术后 12 个月时,特立帕肽对防止格鲁恩区 7 的骨质流失可能有效。在 THA 术后 12 个月时,雷洛昔芬对防止格鲁恩区 2 和 3 的骨质流失略有疗效。在 THA 术后 12 个月时,钙对防止格鲁恩区 5 的骨质流失略有疗效。所有研究均未报告翻修手术:结论:双磷酸盐和地诺单抗可能是有效的抗骨质疏松药物,可预防THA术后因应力屏蔽导致的假体周围股骨近端骨质流失,尤其是无骨水泥近端固定柄,这是全球最常用的假体。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Orthopaedic Science
Journal of Orthopaedic Science 医学-整形外科
CiteScore
3.00
自引率
0.00%
发文量
290
审稿时长
90 days
期刊介绍: The Journal of Orthopaedic Science is the official peer-reviewed journal of the Japanese Orthopaedic Association. The journal publishes the latest researches and topical debates in all fields of clinical and experimental orthopaedics, including musculoskeletal medicine, sports medicine, locomotive syndrome, trauma, paediatrics, oncology and biomaterials, as well as basic researches.
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