Preoperative bisphosphonate treatment may adversely affect the outcome after shoulder arthroplasty

Abstract

Aims The aim of this study was to investigate the effects of preoperative bisphosphonate treatment on the intra- and postoperative outcomes of arthroplasty of the shoulder. The hypothesis was that previous bisphosphonate treatment would adversely affect both intra- and postoperative outcomes. Patients and Methods A retrospective cohort study was conducted involving patients undergoing arthroplasty of the shoulder, at a single institution. Two patients with no previous bisphosphonate treatment were matched to each patient who had received this treatment preoperatively by gender, age, race, ethnicity, body mass index (BMI), and type of arthroplasty. Previous bisphosphonate treatment was defined as treatment occurring during the three-year period before the arthroplasty. The primary outcome measure was the incidence of intraoperative complications and those occurring at one and two years postoperatively. A total of 87 patients were included: 29 in the bisphosphonates-exposed (BP+) group and 58 in the non-exposed (BP-) group. In the BP+ group, there were 26 female and three male patients, with a mean age of 71.4 years (51 to 87). In the BP- group, there were 52 female and six male patients, with a mean age of 72.1 years (53 to 88). Results Previous treatment with bisphosphonates was positively associated with intraoperative complications (fracture; odds ratio (OR) 39.40, 95% confidence interval (CI) 2.42 to 6305.70) and one-year postoperative complications (OR 7.83, 95% CI 1.11 to 128.82), but did not achieve statistical significance for complications two years postoperatively (OR 3.45, 95% CI 0.65 to 25.28). The power was 63% for complications at one year. Conclusion Patients who are treated with bisphosphonates during the three-year period before shoulder arthroplasty have a greater risk of intraoperative and one-year postoperative complications compared with those without this previous treatment.

Increased Risk of Periprosthetic Fractures and Revision Arthroplasty in Patients Undergoing Shoulder Arthroplasty With a History of Prior Fragility Fractures: A Matched Cohort Analysis

“…4 In 2014, the American Academy of Orthopaedic Surgeons recognized osteoporosis and other disorders resulting in poor bone health as a national public health crisis. 14 As fragility fractures may be preventable, preemptively identifying patients with osteoporosis before orthopaedic intervention may be an important strategy to optimize surgical outcomes.…”

Osteoporosis in the Setting of Shoulder Arthroplasty: A Narrative Review

“… 11 In this retrospective study, there was no data about the outcomes of these treated patients. 4 However, a study by Mai et al 22 showed that according to a multivariate analysis controlling for both osteoporosis and osteopenia, patients who received bisphosphonates prior to surgery had a significantly increased risk of intraoperative fractures as well as a statistically significant 8-fold increase in complications at one year, which may or may not require revision surgery, including stress fractures, periprosthetic fractures, aseptic loosening, scapular notching, and periprosthetic fractures. This may be explained by the fact that long-term usage of bisphosphonates may result in an excessive suppression of bone turnover, which affects physiological stress responses, thus increasing the risk of fracture and other complications.…”

“…Examples of such a change of management is stopping bisphosphonates for a while prior to TSA in patients with glenohumeral osteoarthritis. 22 Other options include anabolic agents such as teriparatide, selective estrogen receptor modulators, and RANK-L inhibitors such as denosumab, whose effect does not last for a long time after stopping. 4 , 22 Nonetheless, more studies are needed to assess the utility of osteoporosis treatment and the adequate treatment in this specific clinical scenario.…”

Green tea extract rich in epigallocatechin gallate impairs alveolar bone loss in ovariectomized rats with experimental periodontal disease

“…8,9 The importance of treatment and prevention of osteoporosis and periodontal disease has been reported in the literature, with the use of natural compounds with promising results. 10 Green tea is one of the most popular beverages in the world and its principal compound is the flavonoid epigallocatechin-3-gallate (EGCG), which is considered to be responsible for protective effects against diabetes, hypertension and cardiovascular diseases, as well as for possessing antibacterial properties. [11][12][13] In recent years, a positive relationship between green tea consumption and bone mineral density in postmenopausal women has been established, mainly attributed to EGCG.…”