McDonald Christopher L, Lemme Nicholas J, Testa Edward J, Aaron Roy, Hartnett Davis A, Cohen Eric M
Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Arthroplast Today. 2022 Mar 15;14:133-139. doi: 10.1016/j.artd.2022.02.003. eCollection 2022 Apr.
Considerable interest has been expressed in the use of bisphosphonates to treat periprosthetic osteoporosis with the clinical goals of reducing periprosthetic fractures and prolonging implant survival.
A systematic review was performed with the goal of identifying both basic science and clinical studies related to the risks and benefits of bisphosphonate use in total joint arthroplasty.
Studies have shown that bisphosphonates may increase early bony ingrowth, decrease the postoperative loss of bone mineral density, and increase the longevity of implants by reducing the need for revisions secondary to aseptic loosening. Continuing bisphosphonates for 1 year postoperatively seems to provide the greatest benefit, with only marginal benefit being shown by continuing therapy for up to 2 years. Current data present some concerns for an increased risk of periprosthetic fractures especially in younger patients, and prolonged therapy is not recommended due to the potential risk of atypical femur fractures. Patients should be counseled regarding the risk of side effects of bisphosphonates, including the risk of osteonecrosis of the jaw, which is a rare but serious side effect. They should also be counseled on the risk of atypical femur fractures and gastrointestinal intolerance.
Orthopedic surgeons could consider bisphosphonates for up to 1 year postoperatively regardless of the patient's prior bone mineral density, after discussion regarding the risks and benefits with the patient.
人们对使用双膦酸盐治疗假体周围骨质疏松症表现出浓厚兴趣，其临床目标是减少假体周围骨折并延长植入物使用寿命。
进行了一项系统评价，目的是确定与全关节置换术中使用双膦酸盐的风险和益处相关的基础科学和临床研究。
研究表明，双膦酸盐可能会增加早期骨长入，减少术后骨矿物质密度的流失，并通过减少因无菌性松动而进行翻修的需求来延长植入物的使用寿命。术后持续使用双膦酸盐1年似乎能带来最大益处，持续治疗长达2年仅显示出边际效益。目前的数据对假体周围骨折风险增加存在一些担忧，尤其是在年轻患者中，并且由于非典型股骨骨折的潜在风险，不建议长期治疗。应向患者咨询双膦酸盐副作用的风险，包括颌骨坏死的风险，这是一种罕见但严重的副作用。还应向他们咨询非典型股骨骨折和胃肠道不耐受的风险。
在与患者讨论风险和益处后，骨科医生无论患者先前的骨矿物质密度如何，都可考虑在术后使用双膦酸盐长达1年。
