Zoledronic Acid for Periprosthetic Bone Mineral Density Changes in Patients With Osteoporosis After Hip Arthroplasty—An Updated Meta-Analysis of Six Randomized Controlled Trials

Abstract

Introduction: Periprosthetic bone mineral density (BMD) loss following total hip arthroplasty (THA) may threaten the survival of the implant, especially in patients with osteoporosis. Zoledronic acid (ZA) is the representative of the third generation of bisphosphonates, which were effective in reducing bone loss in conditions associated with accelerated bone turnover. The aim of this study was to evaluate the efficacy and safety of ZA in patients with osteoporosis after THA.Methods: Randomized controlled trials (RCTs) associated with ZA and THA were searched from the MEDLINE, PubMed, EMBASE, Wanfang database, and the Web of Science (August 2021). Other methods, such as hand search and email request were also tried. The methodological quality was assessed by the Risk of Bias (RoB) 2.0. Relevant data were abstracted from the included RCTs and authors were contacted when necessary.Results: In this study, six RCTs involving a total of 307 patients were finally included and analyzed. The pooled data demonstrated that significantly less periprosthetic BMD loss in Gruen zone seven had occurred in the ZA-treated patients than in the control patients at 3 months (mean difference [MD] = 4.03%; 95% CI: 0.29–7.76%; P = 0.03), 6 months (MD = 7.04%; 95% CI: 2.12–11.96%; P = 0.005), and 12 months (MD = 7.12%; 95% CI: 0.33–13.92%; P = 0.04). The Harris Hip Score (HHS) was also significantly increased in ZA group at 6 and 12 months after operation (P = 0.03 and P = 0.02, respectively). Influenza-like symptom was found related to the usage of ZA [relative risk (RR) = 7.03, P < 0.0001].Conclusion: A meta-analysis of six RCTs suggested that ZA was beneficial in maintaining the periprosthetic BMD in patients with osteoporosis at 6 and 12 months after THA. In addition, the HHS was significantly improved in patients treated with ZA. However, the short length of follow-up of the available studies resulted in the lack of analyses regarding the survival of implants including the rate of aseptic loosing, periprosthetic fracture, and revision. It still needs to be determined in research with longer follow-up period.Clinical Trial Registration:Researchregistry.com, identifier: reviewregistry1087.

Curative Effect of Prebiotics/Probiotics Preparations Combined with Zoledronic Acid + Calcitriol Regimen on Patients with Primary Osteoporosis and Their Influences on Bone Metabolism Markers

“…Gut microbes can influence the release of inflammatory factors, resulting in decreased osteoclastogenesis [ 8 , 13 ]. IGF-1 is an important factor affecting bone metabolism.…”

Bone Remodelling of the Proximal Femur After Hip Revision with a Metaphyseal-Fixation Femoral Stem Component

“…Studies have found that postoperative use of antiosteoporosis drugs can reduce the loss of periprosthetic bone mineral density in patients with osteoporosis after primary replacement. 32 Although our findings showed that the application of antiosteoporosis drugs after revision surgery had no significant effect on bone mineral density recovery (considering factors such as the small sample size), we considered that in patients with preoperative osteoporosis, revision surgery should be followed up with antiosteoporosis drugs. The third influencing factor was hip function.…”

Bisphosphonates’ use and risk of aseptic loosening following total hip arthroplasty: a systematic review

“…Zoledronate was the more efficient during the first 12 months, followed by alendronate and etidronate, which www.efortopenreviews.org 8:11 HIP 805 also had long-lasting residual effects after 12 postoperative months (69). Another meta-analysis also supported the positive impact of zoledronate on the periprosthetic BMD preservation and HHS improvement in osteoporotic patients in the first postoperative year after THA (20). Shi et al also demonstrated that BP therapy decreases periprosthetic bone resorption in short-, medium-, and long-term periods (68).…”

“…The BPs' impact on implant fixation in patients undergoing THA has also been evaluated. Numerous studies supported that BPs therapy minimizes periprosthetic bone loss, reduces implants' axial rotation and offers better clinical THA outcomes (20,21,22,23,24,25). However, these parameters do not necessarily ensure the longevity and survival of THA.…”