Effect of zoledronic acid on periprosthetic bone mineral density in osteoporotic patients following total hip replacement

doi:10.3877/cma.j.issn.1674-134X.2020.02.009

Abstract

Abstract:

Objective

To evaluate the effect of zoledronic acid on bone mineral density after total hip arthroplasty in the patients with osteoporosis.

Methods

Main databases from the inception of each database up to 10 November 2019 were electronically searched. Randomized clinical trials (RCTs) of zoledronic acid on bone mineral density after total hip arthroplasty in patients with osteoporosis were included. The Cochrane risk of bias tool was used to assess the risk of bias. The quality of included studies was assessed using the Jadad rating scale. The Cochrane Collaboration’s RevMan5.3 software was used for meta-analysis.

Results

Five studies were included and made a meta-analysis. The meta-analysis results showed that three months after operation, the bone mineral density of Gruen 2 area [mean difference (MD)=0.11, 95% confidence interval (CI) (0.01, 0.21), Z=2.21, P=0.03], Gruen 3 area [MD=0.11, 95% CI (0.01, 0.21), Z=2.24, P=0.03], and Gruen 6 area [MD=0.12, 95% CI (0.04, 0.21), Z=2.76, P=0.006] in the treatment group were significantly higher than those in the control group; six months after operation, the bone mineral density of Gruen 1 area [MD=0.05, 95% CI(0.01, 0.09), Z=2.20, P=0.03], Gruen 2 area [MD=0.08, 95% CI(0.03, 0.14), Z=3.03, P=0.002], Gruen 3 area [MD=0.05, 95% CI (0.00, 0.10), Z=2.10, P=0.04], Gruen 4 area [MD=0.10, 95% CI(0.04, 0.15), Z=3.46, P=0.0005] and Gruen 5 area [MD=0.08, 95% CI (0.03, 0.14), Z=2.87, P=0.004] were significantly higher than those in the control group; 12 months after operation, the bone mineral density of Gruen 1 area [MD=0.09, 95% CI (0.05, 0.14), Z=4.22, P<0.0001], Gruen 2 area [MD=0.11, 95% CI(0.05, 0.16), Z=3.91, P<0.0001], Gruen 3 area [MD=0.08, 95% CI (0.03, 0.13), Z=3.42, P=0.0006], Gruen 4 area [MD=0.15, 95% CI(0.09, 0.20), Z =5.01, P<0.00001] and Gruen 5 area [MD=0.10, 95% CI (0.05, 0.16), Z=3.77, P=0.0002] were significantly higher than those in the control group. No significant adverse reactions occurred in the studies included.

Conclusion

Zoledronic acid can effectively delay the decrease of bone mineral density after total hip arthroplasty, increase the biological stability of the prosthesis, and the clinical application is safe, yet more high quality, multi-center strictly designed RCTs are needed to further verify.

Key words: Zoledronic acid, Osteoporosis, Arthroplasty, replacement, hip, Bone density, Meta-analysis

Xiaolei Liu, Yiqin Zhou, Qirong Qian. Effect of zoledronic acid on periprosthetic bone mineral density in osteoporotic patients following total hip replacement[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2020, 14(02): 179-188.

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Figures/Tables 9

References 20

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纳入研究	发表时间	例数(治疗组/对照组)	年龄(岁)	诊断	假体情况	治疗组	对照组	不良反应
袁宏等^[7]	2014	31(16/15)	[70～83，(73.8± 4.21)]/[70～81，(74.1±4.16)]	骨质疏松髋部骨折并行THA	生物型假体	钙尔奇＋阿尔法D3＋唑来膦酸	钙尔奇＋阿尔法D3	治疗组3例出现发热、头痛及流感样症状，对症治疗后好转
王利等^[12]	2014	108(54/54)	(61±1.2)/(62±1.3)	原发性骨质疏松症接受THA	生物型假体	术后使用唑来膦酸	术后不使用唑来膦酸	未报道
倪小青等^[13]	2015	34(17/17)	(83.32±2.33)/(82.98±2.99)	原发性骨质疏松症实施THA	LINK陶对陶、陶对聚乙烯产品	THA术后加用唑来膦酸	THA术后不加用唑来膦酸	治疗组8例出现发热，乏力、肌肉酸痛等类感冒样症状，对症治疗后好转
Tsan-Wen Huang等^[14]	2017	54(27/27)	(60.1±11.7)/(59.4±13.3)	骨质疏松症实施THA	生物性假体	使用唑来膦酸	使用生理盐水安慰剂	治疗组3例发热、1例低钙血症
周伟等^[15]	2018	32(16/16)	(73.3±6.6)/(74.4± 5.7)	绝经后骨质疏松合并髋部骨折行THA	生物性假体	碳酸钙D3片＋骨化三醇胶囊＋唑来膦酸	碳酸钙D3片＋骨化三醇胶囊	治疗组2例出现低热反应

纳入研究	发表时间	例数(治疗组/对照组)	年龄(岁)	诊断	假体情况	治疗组	对照组	不良反应
袁宏等^[7]	2014	31(16/15)	[70～83，(73.8± 4.21)]/[70～81，(74.1±4.16)]	骨质疏松髋部骨折并行THA	生物型假体	钙尔奇＋阿尔法D3＋唑来膦酸	钙尔奇＋阿尔法D3	治疗组3例出现发热、头痛及流感样症状，对症治疗后好转
王利等^[12]	2014	108(54/54)	(61±1.2)/(62±1.3)	原发性骨质疏松症接受THA	生物型假体	术后使用唑来膦酸	术后不使用唑来膦酸	未报道
倪小青等^[13]	2015	34(17/17)	(83.32±2.33)/(82.98±2.99)	原发性骨质疏松症实施THA	LINK陶对陶、陶对聚乙烯产品	THA术后加用唑来膦酸	THA术后不加用唑来膦酸	治疗组8例出现发热，乏力、肌肉酸痛等类感冒样症状，对症治疗后好转
Tsan-Wen Huang等^[14]	2017	54(27/27)	(60.1±11.7)/(59.4±13.3)	骨质疏松症实施THA	生物性假体	使用唑来膦酸	使用生理盐水安慰剂	治疗组3例发热、1例低钙血症
周伟等^[15]	2018	32(16/16)	(73.3±6.6)/(74.4± 5.7)	绝经后骨质疏松合并髋部骨折行THA	生物性假体	碳酸钙D3片＋骨化三醇胶囊＋唑来膦酸	碳酸钙D3片＋骨化三醇胶囊	治疗组2例出现低热反应

纳入研究	发表时间	随机序列的产生	分配隐藏	参与者盲法	评估者盲法	结局数据完整性	选择报告	其他偏倚	Jadad评分
袁宏等^[7]	2014	L	U	H	U	L	U	L	3
王利等^[12]	2014	L	U	H	U	L	U	L	2
倪小青等^[13]	2015	L	U	H	U	L	U	L	2
Tsan-Wen Huang等^[14]	2017	L	U	L	L	L	U	L	5
周伟等^[15]	2018	L	U	H	L	L	U	L	3

纳入研究	发表时间	随机序列的产生	分配隐藏	参与者盲法	评估者盲法	结局数据完整性	选择报告	其他偏倚	Jadad评分
袁宏等^[7]	2014	L	U	H	U	L	U	L	3
王利等^[12]	2014	L	U	H	U	L	U	L	2
倪小青等^[13]	2015	L	U	H	U	L	U	L	2
Tsan-Wen Huang等^[14]	2017	L	U	L	L	L	U	L	5
周伟等^[15]	2018	L	U	H	L	L	U	L	3

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