1
|
Hatano M, Koizumi Y, Yamamoto N, Miyoshi K, Kawabata K, Tanaka T, Tanaka S, Shiroshita A, Kataoka Y. Anti-osteoporotic drug efficacy for periprosthetic bone loss after total hip arthroplasty: A systematic review and network meta-analysis. J Orthop Sci 2024:S0949-2658(24)00012-5. [PMID: 38342711 DOI: 10.1016/j.jos.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND Periprosthetic bone loss following total hip arthroplasty (THA) threatens prosthesis stability. This systematic review and network meta-analysis aimed to compare the efficacy of anti-osteoporotic drugs for measures of hip function according to functional outcomes, periprosthetic femoral bone mineral density loss in each Gruen zone, and revision surgery after THA. METHODS The systematic search of six literature databases was conducted in December 2021 in accordance with PRISMA guidelines. Adult participants who underwent primary THA were included. A random-effects network meta-analysis was performed within a frequentist framework, and the confidence in the evidence for each outcome was evaluated using the CINeMA tool, which assessed the credibility of results from the network meta-analysis. We included 22 randomized controlled trials (1243 participants) comparing the efficacy and safety of bisphosphonates (including etidronate, clodronate, alendronate, risedronate, pamidronate, and zoledronate), denosumab, selective estrogen receptor modulator, teriparatide, calcium + vitamin D, calcium, and vitamin D. We defined the period for revision surgery as the final follow-up period. RESULTS Raloxifene, bisphosphonate, calcium + vitamin D, and denosumab for prosthetic hip function might have minimal differences when compared with placebos. The magnitude of the anti-osteoporotic drug effect on periprosthetic femoral bone loss varied across different Gruen zones. Bisphosphonate, denosumab, teriparatide might be more effective than placebo in Gruen zone 1 at 12 months after THA. Additionally, bisphosphonate might be more effective than placebo in Gruen zones 2, 5, 6, and 7 at 12 months after THA. Denosumab was efficacious in preventing bone loss in Gruen zones 6 and 7 at 12 months after THA. Teriparatide was likely to be efficacious in preventing bone loss in Gruen zone 7 at 12 months after THA. Raloxifene was slightly efficacious in preventing bone loss in Gruen zones 2 and 3 at 12 months after THA. Calcium was slightly efficacious in preventing bone loss in Gruen zone 5 at 12 months after THA. None of the studies reported revision surgery. CONCLUSIONS Bisphosphonate and denosumab may be effective anti-osteoporotic drugs for preventing periprosthetic proximal femoral bone loss due to stress shielding after THA, particularly in cementless proximal fixation stems, which are the most commonly used prostheses worldwide.
Collapse
Affiliation(s)
- Masaki Hatano
- Department of Orthopaedic and Spine Surgery, Yokohama Rosai Hospital, 3-2-1-1 Kozukue, Kohoku-ku, Kanagawa 222-0036, Japan; Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Yasuhiko Koizumi
- Department of Orthopaedic and Spine Surgery, Yokohama Rosai Hospital, 3-2-1-1 Kozukue, Kohoku-ku, Kanagawa 222-0036, Japan
| | - Norio Yamamoto
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan; Department of Orthopedic Surgery, Miyamoto Orthopedic Hospital, 4-2-63 Kunitomi, Naka-ku, Okayama, Okayama 773-8236, Japan; Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama 700-8558, Japan.
| | - Kota Miyoshi
- Department of Orthopaedic and Spine Surgery, Yokohama Rosai Hospital, 3-2-1-1 Kozukue, Kohoku-ku, Kanagawa 222-0036, Japan
| | - Kensuke Kawabata
- Department of Orthopaedic and Spine Surgery, Yokohama Rosai Hospital, 3-2-1-1 Kozukue, Kohoku-ku, Kanagawa 222-0036, Japan
| | - Takeyuki Tanaka
- Department of Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, The University of Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Sensory and Motor System Medicine, Surgical Sciences, Graduate School of Medicine, The University of Tokyo, Japan
| | - Akihiro Shiroshita
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan; Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, USA
| | - Yuki Kataoka
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan; Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Tanaka Asukai-cho 89, Sakyo-ku, Kyoto 606-8226, Japan; Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan; Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| |
Collapse
|
2
|
Wang C, Shen J, Zhang W, Wang X, Xu X, Lu X, Xu D, Yao L. Aberrant expression of miR-33a-3p/IGF2 in postmenopausal osteoporosis patients and its role and mechanism in osteoporosis. J Orthop Surg Res 2023; 18:487. [PMID: 37415192 DOI: 10.1186/s13018-023-03883-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/26/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND Postmenopausal osteoporosis (PMOP), the most frequent bone-related disease, is characterized by bone loss and fragile fractures, which is related to low bone density (BMD). This study aimed to illustrate the expression and mechanism of miR-33a-3p in osteoporosis. METHODS TargetScan and luciferase reporter assay were applied for verifying the relevance between miR-33a-3p and IGF2. Levels of miR-33a-3p, IGF2, Runx2, ALP and Osterix were checked using RT-qPCR and western blotting. hBMSCs proliferation, apoptosis and ALP activity were analyzed by MTT, flow cytometry (FCM) analysis and ALP detection kit, respectively. Moreover, the calcification of cells was assessed using Alizarin Red S staining. The average BMD was evaluated by dual-energy X-ray absorptiometry (DEXA) assay. RESULTS IGF2 was a target of miR-33a-3p. The level of miR-33a-3p was substantially higher and IGF2 expression was memorably lower in the serum of osteoporosis patients than that in healthy volunteers. Our results also pointed out that miR-33a-3p was reduced and IGF2 expression was enhanced during osteogenic differentiation. We concluded that miR-33a-3p negatively regulated the level of IGF2 in hBMSCs. Besides, miR-33a-3p mimic inhibited the osteogenic differentiation of hBMSCs via inhibiting the level of Runx2, ALP and Osterix and decreasing ALP activity. IGF2 plasmid dramatically reversed the influence of miR-33a-3p mimic on IGF2 expression, hBMSCs proliferation and apoptosis, and osteogenic differentiation of hBMSCs. CONCLUSION miR-33a-3p affected osteogenic differentiation of hBMSCs by targeting IGF2, indicating a potential use of miR-33a-3p as plasma biomarker and therapeutic target for postmenopausal osteoporosis.
Collapse
Affiliation(s)
- Changxin Wang
- Department of Orthopaedics, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, 161000, China
| | - Jianfei Shen
- Nuclear Medicine Department, The Third Affiliated Hospital of Qiqihar Medical University, No. 27 Taishun Street, Tiefeng District, Qiqihar, 161000, China
| | - Wei Zhang
- Endocrine Department, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, 161000, China
| | - Xiaoyu Wang
- Nuclear Medicine Department, The Third Affiliated Hospital of Qiqihar Medical University, No. 27 Taishun Street, Tiefeng District, Qiqihar, 161000, China
| | - Xiaohong Xu
- Department of Clinical Laboratory, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, 161000, China
| | - Xianghui Lu
- Department of Gynaecology, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, 161000, China
| | - Dongbin Xu
- Qiqihar Medical University, Qiqihar, 161000, China
| | - Lan Yao
- Nuclear Medicine Department, The Third Affiliated Hospital of Qiqihar Medical University, No. 27 Taishun Street, Tiefeng District, Qiqihar, 161000, China.
| |
Collapse
|
3
|
Li X, Han J, Shi X, Bi Z, Liu J. Zoledronic acid and denosumab for periprosthetic bone mineral density loss after joint arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Arch Osteoporos 2023; 18:37. [PMID: 36840811 DOI: 10.1007/s11657-023-01227-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/10/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVE Periprosthetic bone mineral density (BMD) loss after total hip arthroplasty (THA) may threaten the survival of implants. Zoledronic acid (ZA) and denosumab were effective in reducing bone loss in conditions associated with accelerated bone turnover by inhibiting osteoclast activity. This meta-analysis aimed to assess the efficiency and safety of ZA and denosumab for periprosthetic BMD loss after THA. METHODS A systematic search of randomized controlled trials (RCTs) associated with ZA or denosumab and THA was performed in MEDLINE, PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the Web of Science from 1980 to 2022. Meta-analysis was performed by the Cochrane Review Manager 5 (RevMan) version 5.41. Cochrane risk of bias tool and GRADEpro were applied for methodological quality and overall evidence quality, respectively. RESULTS Nine RCTs involving a total of 480 patients were finally included and analyzed. The pooled data that demonstrated significantly less periprosthetic BMD loss in Gruen zone 7 occurred in the intervention group patients than in the control group patients at 3 months (MD = 4.30, 95% CI: 1.78-6.82, P = 0.0008), 6 months (MD = 7.71, 95% CI: 5.41-10.02, P < 0.00001), and 12 months (MD = 8.19, 95% CI: 5.97-10.42, P < 0.00001) after THA. No serious adverse events (AEs) were observed. CONCLUSION In the current analysis with evidence on the efficacy and safety of ZA and denosumab, the authors recommend the use of ZA or denosumab treatment for periprosthetic bone mineral density loss. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42022369273.
Collapse
Affiliation(s)
- Xiao Li
- Department of Orthopedics, First Hospital of Jilin University, Changchun, Jilin, China
| | - Jingru Han
- Department of Oncology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaotong Shi
- Department of Orthopedics, First Hospital of Jilin University, Changchun, Jilin, China
| | - Zhiguo Bi
- Department of Orthopedics, First Hospital of Jilin University, Changchun, Jilin, China
| | - Jianguo Liu
- Department of Orthopedics, First Hospital of Jilin University, Changchun, Jilin, China.
| |
Collapse
|
4
|
Wang XJ, Bai X, Miu Y, Chen P, Yan PJ, Jiang CX. The assessment value of pathological condition of serum adiponectin and amylin in primary osteoporosis and its correlation analysis with bone metabolism indexes. J Med Biochem 2023; 42:86-93. [PMID: 36819136 PMCID: PMC9920991 DOI: 10.5937/jomb0-35877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/11/2022] [Indexed: 11/02/2022] Open
Abstract
Background This paper explores the assessment value of pathological condition of serum adiponectin (APN) and amylin in primary osteoporosis (POP) and their correlation with bone metabolism indexes. Methods From January 2019 to June 2021, 79 cases of POP patients were selected as the research objects. A test of the patients' bone density was conducted, and clinical grading of POP was via T value (normal, mild, moderate, severe). The analysis of the assessment value of pathological condition of serum APN and amylin for POP and their association with bone metabolism indexes in patients was performed. Results APN and amylin in patients were declined with POP's aggravation. APN of 5.15 μg/mL or less and amylin of 15.38 pmol/L or less were risk factors influencing the aggravation of pathological condition of POP (P< 0 .0 5). The area under the curve (AUC) of combined detection of APN and amylin to assess the severity of POP was elevated vs. alone test of amylin (P< 0.05). 25-hydroxyvitamin D (25-(OH) D) and total type 1 procollagen amino-terminal propeptide (t-PINP) in patients were descended with the aggravation of pathological condition of osteoporosis (P < 0.05). At the same time, no distinct differences were presented in the three groups of type I collagen hydroxyl terminal peptide b degradation product (β-CTX) and N-terminal osteocalcin (N-MID) (P> 0.05). APN, amylin, 25-(OH)D, β-CTX, and t-PINP were negatively linked with POP clinical grade (P< 0.05). APN and amylin were associated with 25-(OH) D, β-CTX, t-PINP (P< 0.05), and APN and amylin were not linked with N-MID (P> 0.05). Conclusions Serum APN and amylin are provided with evaluation values for the severity of POP and are associated with bone metabolism in patients.
Collapse
Affiliation(s)
- Xiao Jie Wang
- Southwest Medical University, Affiliated Hospital, Department of Endocrinology and Metabolism, Luzhou City, Sichuan Province, China
| | - Xue Bai
- Southwest Medical University, Affiliated Hospital, Department of Endocrinology and Metabolism, Luzhou City, Sichuan Province, China
| | - Ying Miu
- Southwest Medical University, Affiliated Hospital, Department of Endocrinology and Metabolism, Luzhou City, Sichuan Province, China
| | - Pan Chen
- Southwest Medical University, Affiliated Hospital, Department of Endocrinology and Metabolism, Luzhou City, Sichuan Province, China
| | - Pi Jun Yan
- Southwest Medical University, Affiliated Hospital, Department of Endocrinology and Metabolism, Luzhou City, Sichuan Province, China
| | - Chun Xia Jiang
- Southwest Medical University, Affiliated Hospital, Department of Endocrinology and Metabolism, Luzhou City, Sichuan Province, China
| |
Collapse
|
5
|
Sköld C, Kultima K, Freyhult E, Larsson A, Gordh T, Hailer NP, Mallmin H. Effects of denosumab treatment on the expression of receptor activator of nuclear kappa-B ligand (RANKL) and TNF-receptor TNFRSF9 after total hip arthroplasty-results from a randomized placebo-controlled clinical trial. Osteoporos Int 2022; 33:1-8. [PMID: 35608639 PMCID: PMC9463208 DOI: 10.1007/s00198-022-06423-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/04/2022] [Indexed: 10/26/2022]
Abstract
UNLABELLED We investigated whether the drug denosumab modulates the inflammatory response after total hip arthroplasty in a randomized controlled trial. Significantly increased expression of RANKL was found in patients treated with denosumab. This could provide an explanation for the rebound effect with rapid loss of BMD seen after discontinuation of denosumab treatment. PURPOSE To evaluate whether denosumab, a human monoclonal antibody directed against receptor activator of nuclear factor kappa-B ligand (RANKL), modulates the inflammatory response after cementless total hip arthroplasty (THA) in patients with osteoarthritis of the hip. METHODS Sixty-four patients operated with cementless THA were randomized to two doses of 60-mg denosumab or placebo 1-3 days and 6 months postoperatively. Serum samples were analyzed by a multiplex extension assay detecting 92 inflammation-related proteins. Bone turnover markers were assessed. Proteins were analyzed using linear mixed effect models. Validation of conspicuous findings was performed with ELISA. RESULTS Two proteins were significantly affected by denosumab treatment: RANKL and tumor necrosis factor receptor super family member 9 (TNFRSF9). Serum levels of RANKL were more than twice as high in the denosumab than in the placebo group 3 months after surgery (ratio 2.10, p<0.001). Six and 12 months after surgery, the expression of RANKL was still elevated in the denosumab-treated group (ratios 1.50, p < 0.001; 1.47, p =0.002). The expression of TNFRSF9 was lower in the denosumab group at 3 months (ratio 0.68, p<0.001). In the denosumab group, concentrations of bone turnover markers were substantially reduced after 3 months, remained suppressed after 6 and 12 months, but increased above baseline at 24 months after surgery. CONCLUSION Two subcutaneous denosumab injections 6 months apart increase RANKL and depress TNFRSF9 after THA. This provides a possible explanation for the rebound effect on bone turnover markers as well as bone mineral density (BMD) upon withdrawal of denosumab. None of the other measured markers of inflammation was influenced by denosumab treatment.
Collapse
Affiliation(s)
- C Sköld
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
- Department of Orthopaedics, Uppsala University Hospital, Sjukhusvägen, Ing 61, pl 6, 751 85, Uppsala, Sweden.
| | - K Kultima
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - E Freyhult
- Department of Cell and Molecular Biology, Uppsala University, Uppsala, Sweden
| | - A Larsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - T Gordh
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - N P Hailer
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - H Mallmin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
6
|
Effects of Pamidronate Disodium Combined with Calcium on BMD Values and Severity of Pain in Elderly Patients with Osteoporosis Based on Mobile Terminal Platform for Internet of Things. DISEASE MARKERS 2022; 2022:5069918. [PMID: 36016848 PMCID: PMC9398865 DOI: 10.1155/2022/5069918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 12/04/2022]
Abstract
Objective To explore the effects of pamidronate disodium combined with calcium on BMD values and the severity of pain in elderly patients with osteoporosis based on the mobile terminal platform for the Internet of Things. Methods The data of 120 patients admitted to our hospital from January 2019 to December 2020 were retrospectively analyzed. According to the patients' condition and medication wills, they were divided into the experimental group (n = 68) and the control group (n = 52). All patients were given chronic disease management based on the mobile terminals for the Internet of Things, and they received the treatment of bisphosphonates and calcium, with the supplement of calcium at a daily dose of 1000 mg. The control group was given alendronate sodium once a week, and the experimental group was given pamidronate disodium by intravenous infusion three times a month, with the treatment cycle as 1 year. The patients' bone mineral density (BMD) values and the pain indexes were compared after treatment. Results There was no statistical difference in general information between the two groups (p > 0.05). The BMD values of the lumbar vertebrae L2-4, total hip, and femur neck at 6 months and 1 year after treatment in the experimental group were significantly higher than those in the control group (p < 0.001). The pain scores at 6 months and 1 year after treatment in the experimental group were significantly lower than those in the control group (p < 0.001). Conclusion The treatment of pamidronate disodium combined with calcium based on the mobile terminal platform for the Internet of Things can reduce the severity of pain in elderly patients with osteoporosis and improve the BMD, which has a generalization value.
Collapse
|
7
|
Liu X, Li T, Wang F, Sun F, Hu J, Ye X, Wang D, Yang X. Controlling sustained statins release in multi-layered composite scaffolds for healing of osteoporotic bone defects. BIOMATERIALS ADVANCES 2022; 137:212838. [PMID: 35929268 DOI: 10.1016/j.bioadv.2022.212838] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 04/06/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
The risk of fragility fracture sharply increases due to the decreased bone mineral density and toughness in patients with osteoporosis (OP). The local use of bone tissue scaffolds with both mechanical stability and drug-delivery functionality is one of the key strategies for the efficient curing of OP. In this work, we reported a layer-by-layer constructing strategy to fabricate 3-D composite bone tissue scaffolds (eSTPS) by assembling β-tri‑calcium phosphate (β-TCP)/polycaprolactone (PCL) microchips and lovastatin-loaded nanofiber membranes (eLOV/PCL). The eSTPS scaffolds show a strong and suited compressive strength as well as long-term delivery of lovastatin. The in vitro tests indicate well biocompatibility and alkaline phosphatase activity of the scaffolds. The eSTPS scaffolds were implanted into the femur of OP modeled rabbits. After 12 weeks curing, the bone parameters are significantly improved, meanwhile ingrowth of new bone and vascular-like tissue were observed. These results suggest the eSTPS scaffolds to be a promising candidate for the local treatment of OP.
Collapse
Affiliation(s)
- Xilin Liu
- Department of Orthopaedic Surgery, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Science, Affiliated Hospital of University of Electronic Science and Technology, Chengdu 610072, China; Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
| | - Ting Li
- Department of Orthopaedic Surgery, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Science, Affiliated Hospital of University of Electronic Science and Technology, Chengdu 610072, China; Chengdu Medical College, Chengdu 610500, China
| | - Fei Wang
- Department of Orthopaedic Surgery, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Science, Affiliated Hospital of University of Electronic Science and Technology, Chengdu 610072, China
| | - Fanxi Sun
- School of Optoelectronic Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China
| | - Jiang Hu
- Department of Orthopaedic Surgery, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Science, Affiliated Hospital of University of Electronic Science and Technology, Chengdu 610072, China
| | - Xiaojian Ye
- Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200336, China; Department of Orthopaedic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
| | - Dongsheng Wang
- School of Optoelectronic Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, China.
| | - Xiao Yang
- Department of Orthopaedic Surgery, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Science, Affiliated Hospital of University of Electronic Science and Technology, Chengdu 610072, China.
| |
Collapse
|
8
|
Bone metabolic indices: Promising predictors for assessing acromegaly. J Clin Neurosci 2022; 99:239-243. [DOI: 10.1016/j.jocn.2022.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 11/23/2022]
|
9
|
Bisphosphonates in Total Joint Arthroplasty: A Review of Their Use and Complications. Arthroplast Today 2022; 14:133-139. [PMID: 35308048 PMCID: PMC8927797 DOI: 10.1016/j.artd.2022.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/17/2022] [Accepted: 02/11/2022] [Indexed: 11/27/2022] Open
Abstract
Background Considerable interest has been expressed in the use of bisphosphonates to treat periprosthetic osteoporosis with the clinical goals of reducing periprosthetic fractures and prolonging implant survival. Methods A systematic review was performed with the goal of identifying both basic science and clinical studies related to the risks and benefits of bisphosphonate use in total joint arthroplasty. Results Studies have shown that bisphosphonates may increase early bony ingrowth, decrease the postoperative loss of bone mineral density, and increase the longevity of implants by reducing the need for revisions secondary to aseptic loosening. Continuing bisphosphonates for 1 year postoperatively seems to provide the greatest benefit, with only marginal benefit being shown by continuing therapy for up to 2 years. Current data present some concerns for an increased risk of periprosthetic fractures especially in younger patients, and prolonged therapy is not recommended due to the potential risk of atypical femur fractures. Patients should be counseled regarding the risk of side effects of bisphosphonates, including the risk of osteonecrosis of the jaw, which is a rare but serious side effect. They should also be counseled on the risk of atypical femur fractures and gastrointestinal intolerance. Conclusions Orthopedic surgeons could consider bisphosphonates for up to 1 year postoperatively regardless of the patient’s prior bone mineral density, after discussion regarding the risks and benefits with the patient.
Collapse
|
10
|
Fang H, Deng Z, Liu J, Chen S, Deng Z, Li W. The Mechanism of Bone Remodeling After Bone Aging. Clin Interv Aging 2022; 17:405-415. [PMID: 35411139 PMCID: PMC8994557 DOI: 10.2147/cia.s349604] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 03/29/2022] [Indexed: 01/02/2023] Open
Abstract
Senescence mainly manifests as a series of degenerative changes in the morphological structure and function of the body. Osteoporosis is a systemic bone metabolic disease characterized by destruction of bone microstructure, low bone mineral content, decreased bone strength, and increased brittleness and fracture susceptibility. Osteoblasts, osteoclasts and osteocytes are the main cellular components of bones. However, in the process of aging, due to various self or environmental factors, the body’s function and metabolism are disordered, and osteoporosis will appear in the bones. Here, we summarize the mechanism of aging, and focus on the impact of aging on bone remodeling homeostasis, including the mechanism of ion channels on bone remodeling. Finally, we summarized the current clinical medications, targets and defects for the treatment of osteoporosis.
Collapse
Affiliation(s)
- Huankun Fang
- Hand and Foot Surgery Department, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, 518035, People’s Republic of China
- Medical College, Shantou University, Shantou, Guangdong, 515041, People’s Republic of China
| | - Zhiqin Deng
- Hand and Foot Surgery Department, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, 518035, People’s Republic of China
| | - Jianquan Liu
- Hand and Foot Surgery Department, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, 518035, People’s Republic of China
| | - Siyu Chen
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, 518035, People’s Republic of China
| | - Zhenhan Deng
- Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, 518035, People’s Republic of China
- Correspondence: Zhenhan Deng, Department of Sports Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, 3002 Sungang West Road, Shenzhen City, 518025, People’s Republic of China, Tel +86 13928440786, Fax +86 755-83366388, Email
| | - Wencui Li
- Hand and Foot Surgery Department, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen, Guangdong, 518035, People’s Republic of China
- Wencui Li, Department of Hand and Foot Surgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, 3002 Sungang West Road, Shenzhen City, 518025, People’s Republic of China, Tel +86 13923750767, Email
| |
Collapse
|
11
|
Lee JH, Yoon JY, Lee YB. The Use of Intravenous Zoledronate May Reduce Retear Rate after Rotator Cuff Repair in Older Female Patients with Osteoporosis. A First In-Human Prospective Study. J Clin Med 2022; 11:jcm11030836. [PMID: 35160287 PMCID: PMC8836943 DOI: 10.3390/jcm11030836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 12/04/2022] Open
Abstract
The objective of this study was to demonstrate the effect of intravenous (IV) zoledronate administration on rotator cuff healing, retear rate, and clinical outcomes in osteoporotic patients who underwent arthroscopic rotator cuff repair (ARCR) compared with patients with normal bone densities. In this prospective nonrandomized comparative study with propensity score matching, 30 patients who were postoperatively administered IV zoledronate (5 mg) were enrolled as the study group. The control group was matched using 1-to-2 propensity score matching. Radiologic and functional outcomes were evaluated 6 months after surgery. The functional scores in both groups exhibited significant improvement 6 months after surgery. Compared with Group 1 (osteoporosis with IV zoledronate injection) Group 2 (normal bone density) showed significant improvement in their University of California, Los Angeles (UCLA) shoulder score and Constant Shoulder Score (CSS) at 6 months postoperatively. The range of motion improved in both groups at 6 months after surgery. The retear rates according to Sugaya’s classification (IV and V) were 13.3% (4 of 30 patients) and 25% (15 of 60 patients) in Groups 1 and 2, respectively, which established a non-inferiority of Group 1 to the control group. The retear pattern according to Rhee’s classification in Group 1 was type I in all cases, whereas eight cases of type I and seven cases of type II patterns were observed in Group 2, which was statistically insignificant between the groups. In conclusion, anti-osteoporotic drug use is beneficial for patients with osteoporosis to reduce the failure rate after an ARCR of length > 2 cm, especially in older female patients. Moreover, thorough scrutiny is required to detect osteoporosis in patients with rotator cuff tears, especially in female patients.
Collapse
|
12
|
Liu Y, Xu JW, Li MY, Wu LM, Zeng Y, Shen B. Zoledronic Acid for Periprosthetic Bone Mineral Density Changes in Patients With Osteoporosis After Hip Arthroplasty-An Updated Meta-Analysis of Six Randomized Controlled Trials. Front Med (Lausanne) 2022. [PMID: 35004777 DOI: 10.3389/fmed.2021.80128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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.
Collapse
Affiliation(s)
- Yuan Liu
- Department of Orthopedics, National Clinical Research Center for Geriatrics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jia-Wen Xu
- Department of Orthopedics, National Clinical Research Center for Geriatrics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Ming-Yang Li
- Department of Orthopedics, National Clinical Research Center for Geriatrics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Li-Min Wu
- Department of Orthopedics, National Clinical Research Center for Geriatrics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Zeng
- Department of Orthopedics, National Clinical Research Center for Geriatrics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Shen
- Department of Orthopedics, National Clinical Research Center for Geriatrics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
13
|
Liu Y, Xu JW, Li MY, Wu LM, Zeng Y, Shen B. Zoledronic Acid for Periprosthetic Bone Mineral Density Changes in Patients With Osteoporosis After Hip Arthroplasty-An Updated Meta-Analysis of Six Randomized Controlled Trials. Front Med (Lausanne) 2022; 8:801282. [PMID: 35004777 PMCID: PMC8733298 DOI: 10.3389/fmed.2021.801282] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/23/2021] [Indexed: 02/05/2023] Open
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.
Collapse
Affiliation(s)
- Yuan Liu
- Department of Orthopedics, National Clinical Research Center for Geriatrics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jia-Wen Xu
- Department of Orthopedics, National Clinical Research Center for Geriatrics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Ming-Yang Li
- Department of Orthopedics, National Clinical Research Center for Geriatrics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Li-Min Wu
- Department of Orthopedics, National Clinical Research Center for Geriatrics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Zeng
- Department of Orthopedics, National Clinical Research Center for Geriatrics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Shen
- Department of Orthopedics, National Clinical Research Center for Geriatrics, Orthopedics Research Institute, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
14
|
Ma R, Wu M, Li Y, Wang J, Yang P, Chen Y, Wang W, Song J, Wang K. The use of bone turnover markers for monitoring the treatment of osteoporosis in postmenopausal females undergoing total knee arthroplasty: a prospective randomized study. J Orthop Surg Res 2021; 16:195. [PMID: 33731168 PMCID: PMC7968280 DOI: 10.1186/s13018-021-02343-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/09/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Osteoporosis (OP) and osteoarthritis (OA) commonly coexist in postmenopausal females. The decrease in bone density and increase in bone resorption in postmenopausal females with OP may consequently affect the surgical outcome of total knee arthroplasty (TKA). However, clinicians often ignore monitoring the treatment of OP in the perioperative management of TKA. Bone turnover marker (BTM) can timely and accurately reflect bone metabolism to monitor the treatment of OP. The purpose of this study was to investigate the effect of BTM monitoring to guide the treatment of OP in postmenopausal females undergoing TKA. METHODS Postmenopausal females with OP who underwent primary unilateral TKA were randomly divided into two groups (monitoring group and control group), given oral medication (alendronate, calcitriol, and calcium), and followed for 1 year. In the monitoring group, serum BTMs (C-telopeptide of type I collagen (CTX-I), N-terminal propeptide of type I procollagen (PINP), and 25(OH)D) were assessed preoperatively and repeated postoperatively; alendronate was withdrawn when CTX-I and PINP reached the reference interval; and calcitriol and calcium were withdrawn when 25(OH)D reached the reference interval. In the control group, oral medication was implemented for a uniform duration of 3 months. During the 1-year follow-up, the mean maximum total point motion (MTPM) of the tibial component, bone mineral density (BMD), visual analog scale (VAS) score, range of motion, and Oxford Knee Score (OKS) score were obtained. RESULTS In the monitoring group, BTM monitoring prolonged the medication duration, but did not cause more adverse reactions than in the control group. The mean MTPM values at 6 m and 12 m in the monitoring group were lower than those in the control group, and the BMD at 12 m in the monitoring group was significantly higher than that in the control group. Patients in the monitoring group had lower VAS scores at 6 m and higher OKS scores at 6 m and 12 m than those in the control group. CONCLUSION In postmenopausal females with osteoporosis undergoing primary TKA, the application of BTM monitoring to guide the treatment of osteoporosis can enhance bone density, maintain prosthesis stability, and improve surgical outcome. TRIAL REGISTRATION ChiCTR ChiCTR-INR-17010495 . Registered on 22 January 2017.
Collapse
Affiliation(s)
- Rui Ma
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, NO. 157 Xiwu Road, Xi'an, 710004, Shaanxi, People's Republic of China
| | - Mengjun Wu
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, NO. 157 Xiwu Road, Xi'an, 710004, Shaanxi, People's Republic of China
| | - Yongwei Li
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, NO. 157 Xiwu Road, Xi'an, 710004, Shaanxi, People's Republic of China
| | - Jialin Wang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, NO. 157 Xiwu Road, Xi'an, 710004, Shaanxi, People's Republic of China
| | - Pei Yang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, NO. 157 Xiwu Road, Xi'an, 710004, Shaanxi, People's Republic of China
| | - Yuanyuan Chen
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, NO. 157 Xiwu Road, Xi'an, 710004, Shaanxi, People's Republic of China
| | - Wei Wang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, NO. 157 Xiwu Road, Xi'an, 710004, Shaanxi, People's Republic of China
| | - Jinhui Song
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, NO. 157 Xiwu Road, Xi'an, 710004, Shaanxi, People's Republic of China
| | - Kunzheng Wang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, NO. 157 Xiwu Road, Xi'an, 710004, Shaanxi, People's Republic of China.
| |
Collapse
|
15
|
Zhu K, Zhang J, Zhang C, Zhao Z, Gao J, Li X, Xia X, Xu X, Zhang T, Guan J. Therapeutic efficacy of zoledronic acid combined with calcitriol in elderly patients receiving total hip arthroplasty or hemiarthroplasty for osteoporotic femoral neck fracture. Osteoporos Int 2021; 32:559-564. [PMID: 32989470 DOI: 10.1007/s00198-020-05637-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022]
Abstract
UNLABELLED Zoledronic acid could improve the clinical outcome in elderly patients receiving total hip arthroplasty or hemiarthroplasty for osteoporotic femoral neck fracture in the 1-year prospective study. INTRODUCTION To validate the therapeutic efficacy of zoledronic acid (ZOL) in elderly patients with femoral neck fracture who received total hip arthroplasty (THA) or hemiarthroplasty (HA). METHODS Included in this study were 95 elderly patients with femoral neck fractures who received THA/HA between August 2015 and June 2018. They were randomized into a ZOL group and a control group. Patients in ZOL group received a yearly single dose of 5 mg ZOL intravenous injection plus 0.5 μg/day calcitriol and 1000 mg/day calcium carbonate 2 days before THA or HA. Patients in the control group were treated with the same dose of calcitriol and calcium carbonate only without ZOL. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. Bone metabolism markers including the total extension of the peptide type I collagen amino end (P1NP) and beta collagen degradation product (β-CTX) were obtained by serum examination. The postoperative functional outcome was assessed using Harris Hip Score (HHS). RESULTS During the follow-up period, BMD in the ZOL group was improved and significantly higher than that in the control group at 6 and 12 months post-operation. Bone metabolism markers P1NP and β-CTX in ZOL group remained at a relatively low level as compared with that in the control group at 6 months after treatment. No significant difference in the mean HHS and the excellent/good rate of joint function was observed during the follow-up period between the two groups. The occurrence of adverse events in the ZOL group was significantly higher than that in the control group. CONCLUSIONS A single infusion of ZOL shows promise in improving BMD of the healthy side of the femoral neck, lumbar spine, and total hip and decreasing the level of bone markers, which may improve the clinical outcome of patients with osteoporotic femoral neck fractures receiving THA/HA.
Collapse
Affiliation(s)
- K Zhu
- Jinan University, Guangzhou, China
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - J Zhang
- Department of Rheumatology, Changhai Hospital, Shanghai, China
| | - C Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Z Zhao
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - J Gao
- Department of Rheumatology, Changhai Hospital, Shanghai, China
| | - X Li
- Department of Rheumatology, Changhai Hospital, Shanghai, China
| | - X Xia
- Department of Rheumatology, Changhai Hospital, Shanghai, China
| | - X Xu
- Department of Rheumatology, Changhai Hospital, Shanghai, China.
| | - T Zhang
- National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
| | - J Guan
- Department of Orthopaedics, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China.
| |
Collapse
|
16
|
Fu G, Li M, Xue Y, Li Q, Deng Z, Ma Y, Zheng Q. Perioperative patient-specific factors-based nomograms predict short-term periprosthetic bone loss after total hip arthroplasty. J Orthop Surg Res 2020; 15:503. [PMID: 33138840 PMCID: PMC7607681 DOI: 10.1186/s13018-020-02034-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/20/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although medical intervention of periprosthetic bone loss in the immediate postoperative period was recommended, not all the patients experienced periprosthetic bone loss after total hip arthroplasty (THA). Prediction tools that enrolled all potential risk factors to calculate an individualized prediction of postoperative periprosthetic bone loss were strongly needed for clinical decision-making. METHODS Data of the patients who underwent primary unilateral cementless THA between April 2015 and October 2017 in our center were retrospectively collected. Candidate variables included demographic data and bone mineral density (BMD) in spine, hip, and periprosthetic regions that measured 1 week after THA. Outcomes of interest included the risk of postoperative periprosthetic bone loss in Gruen zone 1, 7, and total zones in the 1st postoperative year. Nomograms were presented based on multiple logistic regressions via R language. One thousand Bootstraps were used for internal validation. RESULTS Five hundred sixty-three patients met the inclusion criteria were enrolled, and the final analysis was performed in 427 patients (195 male and 232 female) after the exclusion. The mean BMD of Gruen zone 1, 7, and total were decreased by 4.1%, 6.4%, and 1.7% at the 1st year after THA, respectively. 61.1% of the patients (261/427) experienced bone loss in Gruen zone 1 at the 1st postoperative year, while there were 58.1% (248/427) in Gruen zone 7 and 63.0% (269/427) in Gruen zone total. Bias-corrected C-index for risk of postoperative bone loss in Gruen zone 1, 7, and total zones in the 1st postoperative year were 0.700, 0.785, and 0.696, respectively. The most highly influential factors for the postoperative periprosthetic bone loss were primary diagnosis and BMD in the corresponding Gruen zones at the baseline. CONCLUSIONS To the best of our knowledge, our study represented the first time to use the nomograms in estimating the risk of postoperative periprosthetic bone loss with adequate predictive discrimination and calibration. Those predictive models would help surgeons to identify high-risk patients who may benefit from anti-bone-resorptive treatment in the early postoperative period effectively. It is also beneficial for patients, as they can choose the treatment options based on a reasonable expectation following surgery.
Collapse
Affiliation(s)
- Guangtao Fu
- Division of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province People’s Republic of China
| | - Mengyuan Li
- Division of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province People’s Republic of China
| | - Yunlian Xue
- Division of Statistics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province People’s Republic of China
| | - Qingtian Li
- Division of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province People’s Republic of China
| | - Zhantao Deng
- Division of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province People’s Republic of China
| | - Yuanchen Ma
- Division of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province People’s Republic of China
| | - Qiujian Zheng
- Division of Orthopedics, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province People’s Republic of China
| |
Collapse
|
17
|
Abstract
PURPOSE OF REVIEW The purpose of this review is to critically evaluate the current literature regarding implant fixation in osteoporotic bone. RECENT FINDINGS Clinical studies have not only demonstrated the growing prevalence of osteoporosis in patients undergoing total joint replacement (TJR) but may also indicate a significant gap in screening and treatment of this comorbidity. Osteoporosis negatively impacts bone in multiple ways beyond the mere loss of bone mass, including compromising skeletal regenerative capacity, architectural deterioration, and bone matrix quality, all of which could diminish implant fixation. Recent findings both in preclinical animal models and in clinical studies indicate encouraging results for the use of osteoporosis drugs to promote implant fixation. Implant fixation in osteoporotic bone presents an increasing clinical challenge that may be benefitted by increased screening and usage of osteoporosis drugs.
Collapse
Affiliation(s)
- Kyle D Anderson
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Frank C Ko
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Amarjit S Virdi
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, 60612, USA
| | - D Rick Sumner
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, 60612, USA
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Ryan D Ross
- Department of Cell & Molecular Medicine, Rush University Medical Center, Chicago, IL, 60612, USA.
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, 60612, USA.
| |
Collapse
|
18
|
Kerschan-Schindl K, Tiefenböck TM, Föger-Samwald U, Payr S, Frenzel S, Marculescu R, Gleiss A, Sarahrudi K, Pietschmann P. Circulating Myostatin Levels Decrease Transiently after Implantation of a Hip Hemi-Arthroplasty. Gerontology 2020; 66:393-400. [PMID: 32454508 DOI: 10.1159/000507731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/03/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Muscle and bone metabolism are both important for the healing of fractures and the regeneration of injured muscle tissue. The aim of this investigation was to evaluate myostatin and other regulating factors in patients with hip fractures who underwent hemi-arthroplasty. METHODS Serum levels of myostatin (MSTN), follistatin (FSTN), dickkopf-1 (Dkk1), and periostin (PSTN) as well as markers of bone turnover were evaluated in patients with hip fractures before surgery and twice in the 2 weeks after surgery. These parameters were also evaluated in age- and gender-matched subjects without major musculoskeletal injury. RESULTS MSTN was transiently reduced; its opponent FSTN was transiently increased. Dkk1, the negative regulator of bone mass, and PSTN, a marker of subperiosteal bone formation, increased after surgery. With regard to markers of bone turnover, resorption was elevated during the entire period of observation whereas the early bone formation marker N-terminal propeptide of type I collagen was elevated 12 days after surgery. CONCLUSIONS Unexpectedly, MSTN, a negative regulator of muscle growth, was reduced after surgery compared with before surgery. As musculoskeletal markers are altered during bone healing, they do not reflect general bone metabolism after fracture or joint arthroplasty. This is important because many elderly patients receive treatment for osteoporosis.
Collapse
Affiliation(s)
- Katharina Kerschan-Schindl
- Department of Physical Medicine, Rehabilitation and Occupational Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas M Tiefenböck
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Ursula Föger-Samwald
- Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology, and Immunology, Medical University of Vienna, Vienna, Austria
| | - Stephan Payr
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Stephan Frenzel
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Rodrig Marculescu
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Andreas Gleiss
- Center of Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Kambiz Sarahrudi
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria, .,Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria,
| | - Peter Pietschmann
- Department of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology, and Immunology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
19
|
Hao D, Wang J, Zuo L. Bisphosphonates Can Maintain Periprosthetic Bone Mass Density after Total Hip Replacement, with Controversy in Region of Interest 5. Curr Pharm Des 2020; 26:4925-4933. [PMID: 32321394 DOI: 10.2174/1381612826666200422093213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/01/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Total hip replacement (THR) is the standard surgical treatment of hip diseases. Periprosthetic bone mass density (BMD) loss may be a cause for revision surgery. Bisphosphonates (BPs) are now the principal class medications for osteoporosis. OBJECTIVE To demonstrate the effect of BPs on treating periprosthetic osteoporosis after THR via a meta-analysis of randomized controlled trials (RCTs). METHODS A comprehensive search of PubMed, EMBASE, the Web of Science and the Cochrane Central Register of Controlled Trials was performed for RCTs on the effect of BPs on treating periprosthetic osteoporosis after THR and clinical outcomes relative to controls. The primary outcome measures were the change in BMD in each region of interest (ROI), the change in serum bone turnover marker levels, the change in functional parameters and the risk of adverse effects (AEs). The final search was performed in March, 2020. RESULTS Nine RCTs were included. A total of 359 patients met the inclusion criteria. BPs can clearly maintain periprosthetic BMD in ROIs at 1, 2, 3, 4, 6 and 7 at 6, 12 and 24 months. In addition, BPs can clearly decrease serum procollagen type 1 N-terminal propeptide (P1NP) levels at 12 months. There was no significant difference in the risk of AEs between the BP and control groups; however, BPs can cause more patients to decline participation. CONCLUSION BPs can effectively maintain overall periprosthetic BMD, but BMD in ROI 5 remains controversial. In addition, the safety of BPs is relatively high, but the compliance may be relatively low.
Collapse
Affiliation(s)
- Dongsheng Hao
- Shanxi Bethune Hospital, Taiyuan, Shanxi Province, China
| | - Junjie Wang
- Changzhi Medical College, Changzhi, Shanxi, China
| | - Liyun Zuo
- Medical College of Shanxi Datong University, Datong, Shanxi, China
| |
Collapse
|