Denosumab and zoledronic acid therapy improves BMD in periprosthetic bone

A new study by Xiao Li and team showed that denosumab and zoledronic acid (ZA) are effective treatments against decline in periprosthetic bone mineral density. The findings of this study were published in Archives of Osteoporosis.

Following a total hip arthroplasty (THA), periprosthetic bone mineral density (BMD) loss may endanger the longevity of implants. By suppressing osteoclast activity, zoledronic acid and denosumab were successful in lowering bone loss in diseases linked to rapid bone turnover. In order to evaluate the effectiveness and safety of ZA and denosumab for periprosthetic BMD loss following THA, a meta-analysis was conducted.

MEDLINE, Embase, PubMed, the Cochrane Central Register of Controlled Trials, and the Web of Science were all thoroughly searched from 1980 to 2022 for randomized controlled trials (RCTs) including ZA or denosumab with THA. The Cochrane Review Manager 5 (RevMan) version 5.41 carried out the meta-analysis. For methodological quality and overall evidence quality, the Cochrane Risk of Bias Tool and GRADEpro were used, respectively.

The key findings of this study were:

1. Finally, 480 individuals from nine RCTs were enrolled and examined.

2. The patients in the intervention group experienced significantly less periprosthetic BMD loss in Gruen zone 7 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 than the patients in the control group.

3. There were no reported severe adverse events (AEs).

The authors advocate ZA or denosumab therapy for periprosthetic bone mineral density loss in the present study based on evidence on the effectiveness and safety of ZA and denosumab.

Reference:

Li, X., Han, J., Shi, X., Bi, Z., & Liu, J. (2023). Zoledronic acid and denosumab for periprosthetic bone mineral density loss after joint arthroplasty: a systematic review and meta-analysis of randomized controlled trials. In Archives of Osteoporosis (Vol. 18, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1007/s11657-023-01227-9