In patients with a diagnosis of end-stage hip osteoarthritis undergoing total hip arthroplasty (THA), the use of oral risedronate has been shown to reduce periprosthetic bone resorption around an uncemented femoral stem significantly up to 6 months postsurgery, according to the results of a meta-analysis of randomized controlled trials published in the Journal of Orthopaedic Surgery and Research.
The investigators sought to assess the efficacy of risedronate on the reduction of femoral periprosthetic bone mineral density (BMD) loss in patients following THA. The meta-analysis included only randomized controlled trials. Study outcome measures were periprosthetic BMD, length of hospital stay, and occurrence of adverse events.
A total of 4 randomized controlled trials comprising 198 patients met the study inclusion criteria. Significant differences were observed among trials with respect to periprosthetic BMD in Gruen zone 1 (standard mean difference [SMD], 0.758; 95% CI, 0.469-1.047; P =.000); Gruen zone 2 (SMD, 0.814; 95% CI, 0.523-1.106; P =.000); Gruen zone 3 (SMD, 0.340; 95% CI, 0.059-0.622; P =.018); Gruen zone 6 (SMD, 2.400; 95% CI, 2.029-2.771; P =.000); and Gruen zone 7 (SMD, 2.400; 95% CI, 2.029-2.771; P =.000).
The current meta-analysis had several limitations. Only 4 randomized controlled trials were included, and the sample size in each trial was relatively small. In addition, certain outcome parameters, such as Harris hip scores, were not fully described and were not included in the meta-analysis. The researchers also noted that methodologic weaknesses in randomized controlled trials need to be taken into account when results are analyzed and that the short-term follow-up may lead to underestimation of the efficacy and safety of risedronate. Finally, because there were fewer than 10 studies included in this analysis, publication bias was not explored using a funnel plot.
The researchers noted that no serious adverse events were reported. They concluded that future trials of risedronate treatment following THA should focus on clinically relevant end points such as the risk for fracture and revision arthroplasty.
Yang L. The efficiency of risedronate in reducing bone resorption after total hip arthroplasty: a meta-analysis of randomized control trials at a minimum of 6 months’ follow-up. J Orthop Surg Res. 2018;13(1):88.