Frontiers in pharmacology · 2025
Effectiveness of treatments to prevent femoral periprosthetic bone loss following total hip arthroplasty: a network meta-analysis.
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Zhao Zhi-Hu, Ling Tao, Ye Songqing, Luo Wei, Ma Jian-Xiong, Ma Xinlong
Аннотация
BACKGROUND: The objective of this study was to conduct a systematic review and network meta-analysis (NMA) to compare the efficacy of various anti-osteoporosis drugs in preventing femoral periprosthetic bone loss following total hip arthroplasty (THA).
METHODOLOGY: Randomized controlled trials (RCTs) assessing the clinical efficacy of various anti-osteoporosis drugs and control treatments in preventing periprosthetic bone loss following THA were identified. Outcomes evaluated included bone mineral density (BMD) at 6 months, 12 months, 24 months, and 5-10 years. The network meta-analysis was conducted using Stata 13.0 and R-3.5.1 software with the "gemtc" package.
RESULTS: A total of 33 RCTs with 1,169 patients were included. At 6 months, alendronate, alendronate + alfacalcidol, denosumab, ibandronate, raloxifene, teriparatide + alendronate, and zoledronic acid were beneficial in increasing BMD, with denosumab ranking highest (based on surface under the cumulative ranking curve (SUCRA) values). At 12 months, alendronate, alendronate + alfacalcidol, denosumab, ibandronate, risedronate, and zoledronic acid showed benefits, with alendronate + alfacalcidol ranking highest (SUCRA = 0.97). For 24-month BMD, teriparatide + alendronate ranked highest (SUCRA = 0.82). Analysis of BMD at 5-10 years, involving four studies on alendronate, pamidronate, and placebo, indicated that alendronate achieved the highest SUCRA value (0.87).
CONCLUSION: Both denosumab and bisphosphonates are effective in preventing femoral periprosthetic bone loss following THA. Denosumab was the most efficient agent for increasing BMD at 6 months post-THA, while alendronate combined with alfacalcidol or feriparatide was most efficient at 12 months and 24 months. More high-quality direct comparisons and long-term follow-up studies are needed to determine the optimal drug and dosage for THA patients.
METHODOLOGY: Randomized controlled trials (RCTs) assessing the clinical efficacy of various anti-osteoporosis drugs and control treatments in preventing periprosthetic bone loss following THA were identified. Outcomes evaluated included bone mineral density (BMD) at 6 months, 12 months, 24 months, and 5-10 years. The network meta-analysis was conducted using Stata 13.0 and R-3.5.1 software with the "gemtc" package.
RESULTS: A total of 33 RCTs with 1,169 patients were included. At 6 months, alendronate, alendronate + alfacalcidol, denosumab, ibandronate, raloxifene, teriparatide + alendronate, and zoledronic acid were beneficial in increasing BMD, with denosumab ranking highest (based on surface under the cumulative ranking curve (SUCRA) values). At 12 months, alendronate, alendronate + alfacalcidol, denosumab, ibandronate, risedronate, and zoledronic acid showed benefits, with alendronate + alfacalcidol ranking highest (SUCRA = 0.97). For 24-month BMD, teriparatide + alendronate ranked highest (SUCRA = 0.82). Analysis of BMD at 5-10 years, involving four studies on alendronate, pamidronate, and placebo, indicated that alendronate achieved the highest SUCRA value (0.87).
CONCLUSION: Both denosumab and bisphosphonates are effective in preventing femoral periprosthetic bone loss following THA. Denosumab was the most efficient agent for increasing BMD at 6 months post-THA, while alendronate combined with alfacalcidol or feriparatide was most efficient at 12 months and 24 months. More high-quality direct comparisons and long-term follow-up studies are needed to determine the optimal drug and dosage for THA patients.