Skip to main content
SpringerLink
Log in

A meta-analysis of bisphosphonates for periprosthetic bone loss after total joint arthroplasty

  • Original Article
  • Published:
Journal of Orthopaedic Science

A Letter to the Editor to this article was published on 03 December 2013

A Letter to the Editor to this article was published on 29 November 2013

Abstract

Background

Periprosthetic bone loss, which is common after joint arthroplasty, may cause bone loosening and lead to failed prosthetic fixation. Two previous meta-analyses have confirmed the mid-term effect of bisphosphonates (BPs) in preventing bone loss after arthroplasty. To determine long-term efficacy and gender bias of BPs after joint arthroplasty, we conducted a meta-analysis based on 17 RCTs involving 781 patients to evaluate the effect of BPs.

Methods

Meta-analysis was conducted after a systematic search of Medline, Embase, the Cochrane Collaboration Central Register of Controlled Clinical Trials, CINAHL, and ISI Web of Science, and manual examination of references in selected articles and conference abstracts of key orthopedic journals. Methodological quality and abstracted relevant data were evaluated. In addition to analysis of bone mineral density (BMD), we also conducted systematic analysis of clinically relevant outcomes and bone biochemical markers.

Results

Seventeen trials involving a total of 781 patients were assessed. Significantly less periprosthetic bone loss occurred in the BP-treated group than in the control group at 6 and 12 months (p < 0.0001). This protective effect was not noted at 3 months (p = 0.11) nor from 24–72 months (p = 0.14). The efficacy of BPs in the gender balance, shorter duration, and the non-nitrogenous BPs groups was no different from that for controls. Biochemical bone markers were suppressed in the BPs group. However, clinically relevant outcomes in the BPs group and controls were similar at all times.

Conclusions

The overall moderate-quality evidence from the RCTs confirmed the significant mid-term efficacy of BPs on periprosthetic bone loss after joint arthroplasty. Long-term efficacy of BPs was not observed, and the therapy was of more benefit to women, especially postmenopausal women. To achieve better efficacy, nitrogenous BPs and long duration of treatment may be recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Zhan C, Kaczmarek R, Loyo-Berrios N, Sangl J, Bright RA. Incidence and short-term outcomes of primary and revision hip replacement in the United States. J Bone Joint Surg Am. 2007;89:526–33.

    Article  PubMed  Google Scholar 

  2. Boden HS, Skoldenberg OG, Salemyr MO, Lundberg HJ, Adolphson PY. Continuous bone loss around a tapered uncemented femoral stem: a long-term evaluation with DEXA. Acta Orthop. 2006;77:877–85.

    Article  PubMed  Google Scholar 

  3. Zeng Y, Lai O, Shen B, Yang J, Zhou Z, Kang P, Pei F. A systematic review assessing the effectiveness of alendronate in reducing periprosthetic bone loss after cementless primary THA. Orthopedics. 2011;34.

  4. Lin T, Yan SG, Cai XZ, Ying ZM. Bisphosphonates for periprosthetic bone loss after joint arthroplasty: a meta-analysis of 14 randomized controlled trials. Osteoporos Int. 2012;23:1823–34.

    Article  PubMed  CAS  Google Scholar 

  5. Bhandari M, Bajammal S, Guyatt GH, Griffith L, Busse JW, Schunemann H, Einhorn TA. Effect of bisphosphonates on periprosthetic bone mineral density after total joint arthroplasty. A meta-analysis. J Bone Joint Surg Am. 2005;87:293–301.

    Article  PubMed  Google Scholar 

  6. Furlan AD, Pennick V, Bombardier C, van Tulder M. Updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine. 2009;34:1929–41.

    Article  PubMed  Google Scholar 

  7. Skoldenberg OG, Salemyr MO, Boden HS, Ahl TE, Adolphson PY. The effect of weekly risedronate on periprosthetic bone resorption following total hip arthroplasty: a randomized, double-blind, placebo-controlled trial. J Bone Joint Surg Am. 2011;93:1857–64.

    Article  PubMed  Google Scholar 

  8. Iwamoto N, Inaba Y, Kobayashi N, Ishida T, Yukizawa Y, Saito TA. Comparison of the effects of alendronate and alfacalcidol on bone mineral density around the femoral implant and in the lumbar spine after total hip arthroplasty. J Bone Joint Surg Am. 2011;93:1203–9.

    Article  PubMed  Google Scholar 

  9. Kinov P, Tivchev P, Doukova P, Leithner A. Effect of risedronate on bone metabolism after total hip arthroplasty: a prospective randomised study. Acta Orthop Belg. 2006;72:44–50.

    PubMed  Google Scholar 

  10. Fokter SK, Komadina R, Repse-Fokter A. Effect of etidronate in preventing periprosthetic bone loss following cemented hip arthroplasty: a randomized, double blind, controlled trial. Wiener Klinische Wochenschrift. 2006;118(Suppl 2):23–8.

    Article  PubMed  CAS  Google Scholar 

  11. Yamaguchi K, Masuhara K, Yamasaki S, Fuji T. Efficacy of different dosing schedules of etidronate for stress shielding after cementless total hip arthroplasty. J Orthop Sci. 2005;10:32–6.

    Article  PubMed  CAS  Google Scholar 

  12. Arabmotlagh M, Pilz M, Warzecha J, Rauschmann M. Changes of femoral periprosthetic bone mineral density 6 years after treatment with alendronate following total hip arthroplasty. J Orthop Res. 2009;27:183–8.

    Article  PubMed  Google Scholar 

  13. Arabmotlagh M, Rittmeister M, Hennigs T. Alendronate prevents femoral periprosthetic bone loss following total hip arthroplasty: prospective randomized double-blind study. J Orthop Res. 2006;24:1336–41.

    Article  PubMed  CAS  Google Scholar 

  14. Yamaguchi K, Masuhara K, Yamasaki S, Fuji T, Seino Y. Effects of discontinuation as well as intervention of cyclic therapy with etidronate on bone remodeling after cementless total hip arthroplasty. Bone. 2004;35:217–23.

    Article  PubMed  CAS  Google Scholar 

  15. Trevisan C, Ortolani S, Romano P, Isaia G, Agnese L, Dallari D, Grappiolo G, Cherubini R, Massari L, Bianchi G. Decreased periprosthetic bone loss in patients treated with clodronate: a 1-year randomized controlled study. Calcif Tissue Int. 2010;86:436–46.

    Article  PubMed  CAS  Google Scholar 

  16. Tapaninen TS, Venesmaa PK, Jurvelin JS, Miettinen HJ, Kroger HP. Alendronate reduces periprosthetic bone loss after uncemented primary total hip arthroplasty—a 5-year follow-up of 16 patients. Scand J Surg. 2010;99:32–7.

    PubMed  CAS  Google Scholar 

  17. Yamasaki S, Masuhara K, Yamaguchi K, Nakai T, Fuji T, Seino Y. Risedronate reduces postoperative bone resorption after cementless total hip arthroplasty. Osteoporos Int. 2007;18:1009–15.

    Article  PubMed  CAS  Google Scholar 

  18. Nishioka T, Yagi S, Mitsuhashi T, Miyamoto M, Tamura T, Kobayashi T, Enishi T. Alendronate inhibits periprosthetic bone loss around uncemented femoral components. J Bone Miner Metab. 2007;25:179–83.

    Article  PubMed  CAS  Google Scholar 

  19. Wang CJ, Wang JW, Ko JY, Weng LH, Huang CC. Three-year changes in bone mineral density around the knee after a six-month course of oral alendronate following total knee arthroplasty. A prospective, randomized study. J Bone Joint Surg Am. 2006;88:267–72.

    Article  PubMed  Google Scholar 

  20. Shetty N, Hamer AJ, Stockley I, Eastell R, Willkinson JM. Clinical and radiological outcome of total hip replacement five years after pamidronate therapy. A trial extension. J Bone Joint Surg Br. 2006;88:1309–15.

    PubMed  CAS  Google Scholar 

  21. Wang CJ, Wang JW, Weng LH, Hsu CC, Huang CC, Chen HS. The effect of alendronate on bone mineral density in the distal part of the femur and proximal part of the tibia after total knee arthroplasty. J Bone Joint Surg Am. 2003;85-A:2121–6.

    PubMed  Google Scholar 

  22. Soininvaara TA, Jurvelin JS, Miettinen HJ, Suomalainen OT, Alhava EM, Kroger PJ. Effect of alendronate on periprosthetic bone loss after total knee arthroplasty: a one-year, randomized, controlled trial of 19 patients. Calcif Tissue Int. 2002;71:472–7.

    Article  PubMed  CAS  Google Scholar 

  23. Nehme A, Maalouf G, Tricoire JL, Giordano G, Chiron P, Puget J. Effect of alendronate on periprosthetic bone loss after cemented primary total hip arthroplasty: a prospective randomized study. Rev Chir Orthop Reparatrice Appar Mot. 2003;89:593–8.

    PubMed  CAS  Google Scholar 

  24. Boonen S, Reginster JY, Kaufman JM, Lippuner K, Zanchetta J, Langdahl B, Rizzoli R, Lipschitz S, Dimai HP, Witvrouw R, Eriksen E, Brixen K, Russo L, Claessens F, Papanastasiou P, Antunez O, Su G, Bucci-Rechtweg C, Hruska J, Incera E, Vanderschueren D, Orwoll E. Fracture risk and zoledronic acid therapy in men with osteoporosis. N Engl J Med. 2012;367:1714–23.

    Article  PubMed  CAS  Google Scholar 

  25. Boonen S, Lorenc RS, Wenderoth D, Stoner KJ, Eusebio R, Orwoll ES. Evidence for safety and efficacy of risedronate in men with osteoporosis over 4 years of treatment: results from the 2-year, open-label, extension study of a 2-year, randomized, double-blind, placebo-controlled study. Bone. 2012;51:383–8.

    Article  PubMed  CAS  Google Scholar 

  26. Crandall CJ, Newberry SJ, Diamant A, Lim YW, Gellad WF, Suttorp MJ, Motala A, Ewing B, Roth B, Shanman R, Timmer M, Shekelle PG. Treatment to prevent fractures in men and women with low bone density or osteoporosis: update of a 2007 report; 2012.

  27. Bischoff-Ferrari HA, Dawson-Hughes B, Baron JA, Burckhardt P, Li R, Spiegelman D, Specker B, Orav JE, Wong JB, Staehelin HB, O’Reilly E, Kiel DP, Willett WC. Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials. Am J Clin Nutr. 2007;86:1780–90.

    PubMed  CAS  Google Scholar 

  28. Bonnick S, Broy S, Kaiser F, Teutsch C, Rosenberg E, DeLucca P, Melton M. Treatment with alendronate plus calcium, alendronate alone, or calcium alone for postmenopausal low bone mineral density. Curr Med Res Opin. 2007;23:1341–9.

    Article  PubMed  CAS  Google Scholar 

  29. Im GI, Qureshi SA, Kenney J, Rubash HE, Shanbhag AS. Osteoblast proliferation and maturation by bisphosphonates. Biomaterials. 2004;25:4105–15.

    Article  PubMed  CAS  Google Scholar 

  30. Rodan GA, Reszka AA. Osteoporosis and bisphosphonates. J Bone Joint Surg Am. 2003;85-A Suppl 3:8–12.

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors wish to thank Dr Foker SK, Dr Skoldenberg, Dr Iwamoto, Dr Kinov, and Dr Lin for providing additional data and information from their studies. Funding for this study was provided by the National Natural Science Foundation of China (51075387) and the Scientific and Technological Research Project, Ministry of Health, China (LW201004).

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Affiliated Hospital of Xuzhou Medical College, Xuzhou, Jiangsu, China

    Liang Zhu, Wei Zheng, Feng-Chao Zhao, Yi Guo, Bai-Yi Meng & Kai-Jin Guo

  2. School of Materials Science and Engineering, China University of Mining and Technology, Xuzhou , Jiangsu, China

    Hong-Tao Liu

Authors
  1. Liang Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Wei Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Feng-Chao Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yi Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bai-Yi Meng
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hong-Tao Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Kai-Jin Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kai-Jin Guo.

About this article

Cite this article

Zhu, L., Zheng, W., Zhao, FC. et al. A meta-analysis of bisphosphonates for periprosthetic bone loss after total joint arthroplasty. J Orthop Sci 18, 762–773 (2013). https://doi.org/10.1007/s00776-013-0411-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00776-013-0411-4

Keywords

Search

Navigation