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. 2021 Dec 23:8:801282.
doi: 10.3389/fmed.2021.801282. eCollection 2021.

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

Yuan Liu  1 , Jia-Wen Xu  1 , Ming-Yang Li  1 , Li-Min Wu  1 , Yi Zeng  1 , Bin Shen  1
Affiliations

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

Yuan Liu et al. Front Med (Lausanne). .

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.

Keywords: meta-analysis; osteoporosis; randomized controlled trial; systematic review; total hip arthroplasty; zoledronic acid.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 flow diagram shows 6 RCTs that were included and analyzed.
Figure 2
Figure 2
The forest plot shows periprosthetic bone mineral density (BMD) changes between zoledronic acid (ZA) and control group at 3, 6, and 12 months after total hip arthroplasty (THA) in Gruen zone 1.
Figure 3
Figure 3
The forest plot shows periprosthetic BMD changes between ZA and control group at 3, 6, and 12 months after THA in Gruen zone 2.
Figure 4
Figure 4
The forest plot shows periprosthetic BMD changes between ZA and control group at 3, 6, and 12 months after THA in Gruen zone 3.
Figure 5
Figure 5
The forest plot shows periprosthetic BMD changes between ZA and control group at 3, 6, and 12 months after THA in Gruen zone 4.
Figure 6
Figure 6
The forest plot shows periprosthetic BMD changes between ZA and control group at 3, 6, and 12 months after THA in Gruen zone 5.
Figure 7
Figure 7
The forest plot shows periprosthetic BMD changes between ZA and control group at 3, 6, and 12 months after THA in Gruen zone 6.
Figure 8
Figure 8
The forest plot shows periprosthetic BMD changes between ZA and control group at 3, 6, and 12 months after THA in Gruen zone 7.
Figure 9
Figure 9
The forest plot shows the changes of procollagen type I N-terminal propeptide (PINP) between ZA and control group at 6 and 12 months after THA.
Figure 10
Figure 10
The forest plot shows the Harris hip score (HSS) between ZA and control group at 3, 6, and 12 months after THA.
Figure 11
Figure 11
The forest plot shows the rate of influenza-like symptom between ZA and control group after THA.
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