Department of Osteoporosis, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China.
Medical Affairs and Outcomes Research, Organon Research and Development, Organon (Shanghai) Pharmaceutical Technology Co., Ltd., Shanghai, China.
Osteoporos Int. 2024 Nov;35(11):1897-1907. doi: 10.1007/s00198-024-07191-5. Epub 2024 Aug 8.
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.
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.
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.
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.
先前的证据表明，双膦酸盐（BPs）可能降低骨折患者再次骨折的风险并促进其功能恢复。然而，关于脆性骨折患者最佳治疗起始时间仍存在争议。我们进行了一项荟萃分析，以评估围手术期使用 BPs 的相关证据，并将其与非围手术期和不使用 BPs 进行比较。
检索了 2023 年 2 月前发表在 PubMed、EMBASE、Web of Science 和 Cochrane 图书馆的电子数据库，无任何语言限制。主要结局指标包括骨折愈合率、愈合时间和新发骨折。我们还检查了广泛的次要结局。采用随机效应荟萃分析。
共纳入 19 项临床试验，涉及 2543 名患者。与术后 4-6 周和 10-12 周时非围手术期使用 BPs 的患者相比，围手术期使用 BPs 对愈合率的总体风险比（RR）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 BPs 对愈合率没有影响。对于愈合时间，围手术期和非围手术期之间的平均差异为-0.19 周（95%CI：-1.03，0.64，p=0.65），约在 10-12 周时，表明围手术期开始使用 BPs 对愈合时间没有显著影响。在新发骨折方面，与未使用 BPs 的患者相比，使用 BPs 的总体 RR 为 0.35（95%CI：0.17-0.73，p=0.005），表明与未使用 BPs 的患者相比，BPs 的使用对新发骨折有保护作用。与非 BPs 使用相比，围手术期使用 BPs 与发热（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）等不良体验的发生风险显著增加有关。
围手术期使用 BPs 不会影响愈合过程，并对脆性骨折患者的治疗有积极影响。这些有力的发现强调了围手术期使用 BPs 作为脆性骨折患者可行治疗选择的潜在疗效。
