II. Meta-Analysis of Alendronate for the Treatment of Postmenopausal Women

Cranney, Ann; Wells, George; Willan, Andrew R.; Griffith, Lauren; Zytaruk, Nicole; Robinson, Vivian; Black, Dennis M.; Adachi, Jonathan D.; Shea, Beverley; Tugwell, Peter; Guyatt, Gordon

doi:10.1210/er.2001-2002

Cited by 385 publications

(178 citation statements)

References 28 publications

(30 reference statements)

Supporting

Mentioning

158

Contrasting

Unclassified

Order By: Relevance

“…We acknowledge that there may have been changes in patient BMD from the time of the DEXA scan to actual THA; however, this time period has been previously used and our methodology was thus consistent with published data [28]. There may be a further change in BMD after initiation of a bisphosphonate but that change tends to be only 3% to 5%, even after 3 years of bisphosphonate treatment, and not likely to affect DEXA scores significantly [8]. The definition of bisphosphonate user included high adherence and use for a minimum of 6 months, which did not fully account for dose, duration, and patient compliance to bisphosphonate use in all patients.…”

Section: Discussionsupporting

confidence: 66%

Association of Bisphosphonate Use and Risk of Revision After THA: Outcomes From a US Total Joint Replacement Registry

Khatod

Inacio

Dell

et al. 2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Total hip arthroplasty (THA) is often performed in patients who are older and may take bisphosphonates to treat a variety of conditions, most commonly osteoporosis. However, the clinical effects of bisphosphonate use on patients who have undergone THA are not well described. Questions/purposes (1) Is bisphosphonate use in patients with osteoarthritis undergoing primary THA associated with a change in the risk of all-cause revision, aseptic revision, or periprosthetic fracture compared with patients not treated with bisphosphonates? (2) Does the risk of bisphosphonate use and revision and periprosthetic fracture vary by patient bone mineral density and age? Methods A retrospective cohort study of 12,878 THA recipients for the diagnosis of osteoarthritis was conducted; 17.8% of patients were bisphosphonate users. Data sources for this study included a joint replacement registry (93% voluntary participation) and electronic health records and an osteoporosis screening database with complete capture of cases as part of the Kaiser Permanente integrated healthcare system. The endpoints for this study were revision surgery for any cause, aseptic revision, and periprosthetic fracture. The exposure of interest was bisphosphonate use; patients were considered users if prescriptions were continuously refilled for a period equal to or longer than 6 months. Bone quality (based on dual-energy x-ray absorptiometery ordered based on the National Osteoporosis Foundation's clinical guidelines taken within 5 years of the THA) and patient age (\ 65 versus C 65 years) were evaluated as effect modifiers. Patient, surgeon, and hospital factors were evaluated as confounders. Cox proportional hazards models were used. Hazard ratios (HRs) and 95% confidence intervals (CIs) were determined. Results Age-and sex-adjusted risks of all-cause (HR, 0.50; 95% CI, 0.33-0.74; p \ 0.001) and aseptic revision Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. HR, 0.53; 95% CI,; p = 0.004) was lower in bisphosphonate users than in nonusers. The adjusted risk of periprosthetic fractures in patients o...

show abstract

Section: Discussionsupporting

confidence: 66%

Association of Bisphosphonate Use and Risk of Revision After THA: Outcomes From a US Total Joint Replacement Registry

Khatod

Inacio

Dell

et al. 2015

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…A meta-analysis included 11 randomized placebo-controlled trials of 12 855 postmenopausal women. 97 These trials were of at least 1-year duration and used daily doses ranging from 5 to 40 mg. BMD increases were dose dependant, particularly for doses 10 mg or greater. Three years of therapy with alendronate resulted in BMD increases of 7.48% (P < 0.01) in the lumbar spine and 5.6% (P < 0.01) in the total hip.…”

Section: 96mentioning

confidence: 99%

“…The pooled relative risk reduction for vertebral fractures with doses of 5 mg or greater was 48% (P < 0.01); and in those who were treated with doses of 10 mg or greater, the relative risk reduction in non-vertebral fracture was 49% (P < 0.01). 97 In postmenopausal women with a prevalent vertebral fracture from the vertebral fracture arm of the Fracture Intervention Trial (FIT), treatment with alendronate reduced the incidence of hip fractures by 51% (P = 0.047) over 3 years. 98 In a post hoc pooled analysis of the vertebral fracture and clinical fracture arms of FIT, alendronate reduced the relative risk of hip fracture by 53% (P = 0.005) over 3 to 4 years in postmenopausal women with a prevalent vertebral fracture or a femoral neck BMD T-score of −2.5 or less.…”

Section: 96mentioning

confidence: 99%

“…Tolerability and Safety-Adverse effects from bisphosphonates are rare, and in a metaanalysis of cyclical etidronate, 96 alendronate, 97 and risedronate, 102 there was no difference in withdrawals, compared with placebo for adverse events. The most frequent concerns associated with cyclical etidronate are diarrhea, nausea, and, rarely, osteomalacia if cyclical therapy is not used.…”

Section: Sogc Clinical Tipmentioning

confidence: 99%

See 1 more Smart Citation

Canadian Consensus Conference on Osteoporosis, 2006 Update

Brown¹,

Fortier²,

Frame

et al. 2006

Journal of Obstetrics and Gynaecology Canada

View full text Add to dashboard Cite

Objective-To provide guidelines for the health care provider on the diagnosis and clinical management of postmenopausal osteoporosis.Outcomes-Strategies for identifying and evaluating high-risk individuals, the use of bone mineral density (BMD) and bone turnover markers in assessing diagnosis and response to management, and recommendations regarding nutrition, physical activity, and the selection of pharmacologic therapy to prevent and manage osteoporosis. Values-The quality of evidence is rated using the criteria described in the report of the Canadian Task Force on the Periodic Health Examination. Recommendations for practice are ranked according to the method described in this report.

show abstract

“…Etidronate, the oldest bisphosphonate, has been shown to reduce the risk of vertebral fracture while, alendronate and risedronate have demonstrated a risk reduction for hip and wrist fractures as well [36][37][38]. The safety profile is more favourable for bisphosphonate than for HRT.…”

Section: Treatments For Osteoporosismentioning

confidence: 99%