Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, No.88 Jiefang Road, Hangzhou, 310009, People's Republic of China.
Department of Endocrinology and Metabolism, Sir Run Run Shaw Hospital Affiliated with School of Medicine, Zhejiang University, No. 3 Qingchun Road, Hangzhou, 310009, People's Republic of China.
Osteoporos Int. 2018 Jul;29(7):1525-1537. doi: 10.1007/s00198-018-4488-7. Epub 2018 Apr 13.
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.
本荟萃分析旨在评估双膦酸盐（BPs）在关节置换术后长期维持假体周围骨密度（BMD）的疗效。它证实了 BPs 在长期随访中的保护作用，并发现了影响这种作用的因素。
假体周围骨丢失被认为是导致关节置换术后无菌性松动和假体固定失败的原因。本荟萃分析纳入了高质量的随机对照试验，旨在分析 BPs 对全膝关节置换术后假体周围骨密度的维持作用。
通过计算机检索文献数据库，共纳入 25 项 RCT 研究，共 1163 名参与者。计算加权均数差值及其 95%置信区间，以评估 BPs 对总假体周围 BMD 和不同 Gruen 区 BMD 的疗效。亚组分析确定了手术部位、骨水泥固定和 BPs 类型等潜在影响因素。对与 BPs 相关的不良反应进行描述性综述。
与对照组相比，BPs 组在关节置换后 3、6、12 个月、2-4 年和 5-10 年时总假体周围 BMD 显著更高（P<0.05）。BPs 组在股骨 Gruen 区 1 和 7 的假体周围 BMD 也显著高于对照组，在 3、6、12 个月、2-4 年和 5-10 年时（P<0.05）。通过将全髋关节置换术和全膝关节置换术分为两个亚组，最小化了异质性。亚组分析显示，在骨水泥固定和非骨水泥固定的关节置换中，BPs 对 BMD 保留的效果在 12 个月和 5-10 年时差异有统计学意义（P<0.05），第二代和第三代 BPs 的疗效显著优于第一代 BPs，在 6 和 12 个月时差异有统计学意义（P<0.05）。纳入的研究均未描述与 BPs 相关的严重或致命的不良反应。
BPs 在关节置换术后长期维持假体周围 BMD 方面具有显著疗效。为了获得更好的疗效，建议使用骨水泥固定和第二代、第三代 BPs。
