Bisphosphonate use before Primary THA May Elevate Risk of Periprosthetic Hip Fracture
Bisphosphonates are a group of drugs that work by slowing bone resorption by reducing osteoclast function. Many studies have shown that this class of medication can improve bone density and reduce the risk of fracture in patients with a reduced bone density. Bisphosphonates can be taken orally through intravenous infusion.
In patients with osteoporosis, the use of bisphosphonates before undergoing primary total hip arthroplasty is an independent risk factor for periprosthetic fractures, says Dr Serino and colleagues in the study “Bisphosphonate Use may be Associated with an Increased Risk of Periprosthetic Hip Fracture.”
Osteoporosis is prevalent in patients undergoing primary total hip arthroplasty (THA).
Researchers evaluated the bisphosphonate effect in treating osteoporotic patients undergoing primary THA using a database of 30,137 patients.
These patients had osteoporosis before primary, elective THA (2010 – 2020). The exclusion criteria included patients undergoing non-elective THA and using corticosteroids/ medications for osteoporosis.
Bisphosphonate users and those who were naïve to bisphosphonates were matched in a 1:1 ratio based on age, sex, Elixhauser comorbidity index, and a history of obesity, rheumatoid arthritis, tobacco use, and alcohol abuse. Kaplan-Meier and multivariate analyses were used to compare the outcomes between the two groups over two years.
The key results of the study are:
- The use of bisphosphonate had an association with a higher two-year rate of periprosthetic fracture.
- There was a trend towards a more significant risk of revision with bisphosphonate use with OR 1.19.
- There was no statistical difference in infection rates, aseptic loosening, dislocation, and mortality between bisphosphonate users and bisphosphonate naïve patients.
They said bisphosphonate use before primary THA is an independent risk factor for periprosthetic fracture among osteoporotic patients.
There needs to be the availability of longer-term data to determine this association's underlying mechanism and identify preventative measures.
Further reading:
Serino J 3rd, Terhune EB, Harkin W, Weintraub MT, Baim S, Della Valle CJ. Bisphosphonate Use may be Associated with an Increased Risk of Periprosthetic Hip Fracture. J Arthroplasty. 2023 Aug 14:S0883-5403(23)00822-7. doi 10.1016/j.arth.2023.08.029.
