The Healing and therapeutic effects of perioperative bisphosphonate use in patients with fragility fractures: meta-analysis of 19 clinical trials.

IF 4.2 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Osteoporosis International Pub Date : 2024-11-01 Epub Date: 2024-08-08 DOI:10.1007/s00198-024-07191-5
Yuhong Zeng, Yuan Yang, Jue Wang, Guolin Meng
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引用次数: 0

Abstract

Objectives: Previous evidence suggests that bisphosphonates (BPs) may lower the risk of recurrent fractures and enhance functional recovery in patients with fractures. However, there has been controversy regarding the optimal timing of treatment initiation for patients with fragility fractures. We conducted a meta-analysis to evaluate the available evidence on the use of BPs during the perioperative period and compared it to both non-perioperative periods and non-usage.

Methods: Electronic searches were performed using PubMed, EMBASE, Web of Science and the Cochrane Library published before February 2023, without any language restrictions. The primary outcomes included fracture healing rate, healing time, and new fractures. We also examined a wide range of secondary outcomes. Random effects meta-analysis was used.

Results: A total of 19 clinical trials involving 2543 patients were included in this meta-analysis. When comparing patients with non-perioperative BPs use in 4-6 weeks and approximately 10-12 weeks post-surgically, the overall risk ratios (RRs) of perioperative BPs use for healing rate were 1.06 (95% CI: 0.81, 1.38, p=0.69) and 1.02 (95% CI: 0.94, 1.11, p=0.65), respectively, suggesting no difference in healing rate between perioperative and non-perioperative BP initiation. For healing time, the overall mean difference between perioperative and non-perioperative periods was -0.19 week (95% CI: -1.03, 0.64, p=0.65) at approximately 10-12 weeks, indicating no significant impact of perioperative BP initiation on healing time. In terms of new fractures, the overall RR with BP use was 0.35 (95% CI: 0.17-0.73, p=0.005), when compared to patients without BPs use. This suggests a protective impact of BP use against new fractures compared to patients without BP use. Perioperative BP use was associated with a markedly higher likelihood of having adverse experiences, including fever (RR: 23.78, 95% CI: 8.29, 68.21, p< 0.001), arthralgia (RR: 10.20, 95% CI: 2.41, 43.16, p=0.002), and myalgia (RR: 9.42, 95% CI: 2.54, 34.87, p< 0.001), compared with non-BPs use.

Conclusions: Treatment with BP during the perioperative period does not affect the healing process and has positive effects on therapy for patients with fragility fractures. These compelling findings underscore the potential efficacy of BP use during the perioperative period as a viable treatment option for patients with fragility fractures.

Abstract Image

脆性骨折患者围手术期使用双膦酸盐的愈合和治疗效果:19 项临床试验的荟萃分析。
目的:以往的证据表明,双膦酸盐(BPs)可降低骨折患者复发骨折的风险并促进其功能恢复。然而,关于脆性骨折患者开始治疗的最佳时机一直存在争议。我们进行了一项荟萃分析,评估在围手术期使用保压药的现有证据,并将其与非围手术期和不使用保压药进行比较:使用 PubMed、EMBASE、Web of Science 和 Cochrane Library 对 2023 年 2 月之前发表的文章进行电子检索,没有任何语言限制。主要结果包括骨折愈合率、愈合时间和新骨折。我们还研究了一系列次要结果。我们采用了随机效应荟萃分析法:本次荟萃分析共纳入了 19 项临床试验,涉及 2543 名患者。在比较术后4-6周和术后约10-12周使用非围手术期保压药物的患者时,围手术期使用保压药物对愈合率的总体风险比(RRs)分别为1.06(95% CI:0.81,1.38,p=0.69)和1.02(95% CI:0.94,1.11,p=0.65),表明围手术期和非围手术期开始使用保压药物在愈合率方面没有差异。在愈合时间方面,围手术期与非围手术期的总体平均差异为-0.19周(95% CI:-1.03,0.64,P=0.65),约为10-12周,表明围手术期开始使用血压计对愈合时间没有显著影响。就新骨折而言,与未使用降压药的患者相比,使用降压药的总RR为0.35(95% CI:0.17-0.73,P=0.005)。这表明,与未使用降压药的患者相比,使用降压药对新发骨折具有保护作用。与未使用血压计的患者相比,围手术期使用血压计的患者出现发热(RR:23.78,95% CI:8.29,68.21,p< 0.001)、关节痛(RR:10.20,95% CI:2.41,43.16,p=0.002)和肌痛(RR:9.42,95% CI:2.54,34.87,p< 0.001)等不良反应的可能性明显增加:结论:围手术期使用 BP 不会影响愈合过程,对脆性骨折患者的治疗有积极作用。这些令人信服的研究结果表明,在围手术期使用血压计作为治疗脆性骨折患者的一种可行方法具有潜在的疗效。
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
Osteoporosis International
Osteoporosis International 医学-内分泌学与代谢
CiteScore
8.10
自引率
10.00%
发文量
224
审稿时长
3 months
期刊介绍: An international multi-disciplinary journal which is a joint initiative between the International Osteoporosis Foundation and the National Osteoporosis Foundation of the USA, Osteoporosis International provides a forum for the communication and exchange of current ideas concerning the diagnosis, prevention, treatment and management of osteoporosis and other metabolic bone diseases. It publishes: original papers - reporting progress and results in all areas of osteoporosis and its related fields; review articles - reflecting the present state of knowledge in special areas of summarizing limited themes in which discussion has led to clearly defined conclusions; educational articles - giving information on the progress of a topic of particular interest; case reports - of uncommon or interesting presentations of the condition. While focusing on clinical research, the Journal will also accept submissions on more basic aspects of research, where they are considered by the editors to be relevant to the human disease spectrum.
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