Bisphosphonate use and risk of post-operative fracture among patients undergoing a total knee replacement for knee osteoarthritis: a propensity score analysis

Prieto-Alhambra, Daniel; Javaid, M K; Judge, Andrew; Maskell, J; Kiran, Amit; Cooper, Cyrus; Arden, N K

doi:10.1007/s00198-010-1368-1

Cited by 23 publications

(11 citation statements)

References 37 publications

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“…In our previous population-based cohort study, we showed a clinically significant reduction in fracture risk, of ϳ50%, after TKR in patients receiving bisphosphonates in primary prevention, and a reduction in risk of 55% in those treated in secondary prevention (36,37). This would support the fact that bisphosphonates could have a potential effect on fracture risk reduction up to 5 years after surgery among patients with lower-limb OA who undergo a joint replacement.…”

Section: Discussionsupporting

confidence: 57%

Fracture risk before and after total hip replacement in patients with osteoarthritis: Potential benefits of bisphosphonate use

Prieto-Alhambra¹,

Javaid²,

Judge³

et al. 2011

Arthritis & Rheumatism

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Objective. The association between osteoarthritis (OA) and fractures remains unclear. OA patients have increased bone mass, but no corresponding decrease in fracture rate. This study was undertaken to determine the fracture rates in patients with hip OA undergoing a total hip replacement (THR), as compared with diseasefree controls, and to assess the association between bisphosphonate use and postsurgery fracture risk.Methods. We conducted a population-based parallel-cohorts study. All patients in the UK General Practice Research Database undergoing a THR for hip OA between 1986 and 2006 constituted the exposed cohort (n ‫؍‬ 14,133). Five disease-free controls were matched with each patient by age, sex, and practice site. Subjects were followed up for 5 years before and after surgery. Fracture rates and rate ratios (RRs) were estimated using Poisson regression. In addition, bisphosphonate use was identified among patients undergoing THR, and the data, stratified by the presence or absence of a previous fracture and by treatment propensity score, were assessed using fitted Cox models to study the effect of bisphosphonate use on the risk of fracture postsurgery.Results. Patients undergoing a THR had a similar fracture risk as that in controls in the 5 years before THR, but had higher rates postsurgery, which peaked at years 2. Conclusion. This study identified a 25% increase in fracture risk at 2.5-5 years postsurgery among patients undergoing a THR. Bisphosphonate use reduced the post-THR risk of fracture when administered both as primary prevention and as secondary prevention, by 44% and 52%, respectively. This must be further confirmed in randomized controlled trials.

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Section: Discussionsupporting

confidence: 57%

Fracture risk before and after total hip replacement in patients with osteoarthritis: Potential benefits of bisphosphonate use

Prieto-Alhambra¹,

Javaid²,

Judge³

et al. 2011

Arthritis & Rheumatism

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“…The analyses of the association between each drug use and fracture (cases vs controls) were carried out using conditional logistic regression. These models were adjusted for the corresponding propensity score in order to minimise confounding for indication [14][15][16][17][18]. As a sensitivity analysis, we carried out a further propensity-matched analysis, where users of the various antidepressants and anxiolytics and sedatives were matched 1:1 to non-users on the propensity score using a 0.2 standard deviation calliper, as recommended by some authors [19].…”

Section: Statisticsmentioning

confidence: 99%

Fractures in users of antidepressants and anxiolytics and sedatives effects of age and dose

Vestergaard

Prieto-Alhambra²,

Javaid

et al. 2012

Bone

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Aim-To study the effects of age and dose of selective serotonin reuptake inhibitors (SSRI), trycyclic antidepressants (TCA) and anxiolytics/sedatives on fracture risk. Subjects and methods-Case control study. From the Danish National Health Service, we identified 124,655 fracture cases and 373,962 age-and gender-matched controls. Crude odds ratios (OR) were estimated, and propensity score adjustment was used to minimize confounding by indication. Results-A higher risk of fractures was associated with an increasing dose of anxiolytics and sedatives; the highest excess risk was present in the age stratum below 40 years of age (p<0.01), and thereafter the excess risk of fractures declined with age. For SSRI, a growing excess risk of fractures was seen with both increasing dose and age. Regarding TCA, no particular trend with age was present. However, an increasing risk of fractures was associated with increasing TCA dose in the age group above 60 years. Finally, for other antidepressants no particular trend with age or dose was observed. In our data, a hospital diagnosis of depression or manic-depression was associated with fewer fractures. Conclusion-Caution should be shown upon prescription of SSRI to older subjects. A hospital diagnosis of depression or manic-depression and thus potentially more severe disease was not a risk factor for fractures.

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“…[22] However, In our study, in bisphosphonate treatment group, total hip BMD was significantly increased compared to non-treatment group regardless of operation sites whether unilateral or bilateral and osteoporosis diagnosis. Prieto-Alhambra et al[23] assessed the effect of bisphosphonate use on post TKR fracture risk and reported that the HR associated with bisphosphonate therapy after TKR was 0.5 in non-fractured patients previously and 0.45 in subjects with osteoporotic and with other previous fracture. This suggested bisphosphonate treatment after TKR reduced the risk of fracture by 50-55%.…”

Section: Discussionmentioning

confidence: 99%

Bone Mineral Density Changes after Total Knee Replacement in Women Over the Age of 65

Hahn

Won

2013

J Bone Metab

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BackgroundThere are few reports on bone mineral density (BMD) changes of axial bones after total knee replacement (TKR) due to severe osteoarthritis (OA) of the knee joint and its results are controversial. The purpose of our study was to measure the BMD changes of hip and spine in patients receiving TKR due to severe OA and to identify clinical factors relating BMD changes.MethodsAmong 66 female patients above 65 years old who underwent TKR due to severe OA and checked preoperative BMD, 52 patients who checked 1 year follow up BMD were enrolled. We investigated the association of the BMD changes with bilaterality of operation, obesity, preoperative knee functional scores, bisphosphonate medication, and diagnosis of osteoporosis.ResultsWe found no correlation between BMD changes and bilaterality of operation, obesity, preoperative knee functional scores and diagnosis of osteoporosis. Spine BMD increased in non-treatment and bisphosphonate treatment group but total hip BMD significantly increased in bisphosphonate treatment group.ConclusionsBisphosphonate treatment for 1 year prevents early reduction of hip BMD just after TKR regardless osteoporosis diagnosis. We considered that the bisphosphonate medication would be beneficial to prevention of later hip fracture in elderly patient receiving TKR due to severe OA of knee joints.

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Bisphosphonate use and risk of post-operative fracture among patients undergoing a total knee replacement for knee osteoarthritis: a propensity score analysis

Abstract: Our results suggest that BPU in primary prevention could reduce post-operative risk of fracture by 50% and by 55% in secondary prevention.

Cited by 23 publications

References 37 publications

Fracture risk before and after total hip replacement in patients with osteoarthritis: Potential benefits of bisphosphonate use

Fracture risk before and after total hip replacement in patients with osteoarthritis: Potential benefits of bisphosphonate use

Fractures in users of antidepressants and anxiolytics and sedatives effects of age and dose

Bone Mineral Density Changes after Total Knee Replacement in Women Over the Age of 65

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