Abstract
This study aimed to determine whether bisphosphonates exert an effect on preventing femoral head collapse after osteonecrosis of the femoral head (ONFH) in an animal model and in clinical trials. A systematic literature search was performed for studies published up to January 2017. Twenty-three articles (16 animal studies, seven clinical trials) were included in the meta-analysis. We found that the bisphosphonate group obtained significant improvement in epiphyseal quotients (MD = 15.32; 95% CI, 9.25–21.39) and provided better performance on bone volume (SMD = 1.57; 95% CI, 0.94–2.20), trabecular number (SMD = 1.30; 95% CI, 0.80–1.79), trabecular thickness (SMD = 0.77; 95% CI, 0.10–1.43) and trabecular separation (SMD = −1.44; 95% CI, −1.70 to −0.58) in the animal model. However, the bisphosphonate group did not achieve better results in pain score, Harris score, the occurrence rate of femoral head collapse, or total hip arthroplasty in the clinical trials. In conclusion, despite bisphosphonates significantly improving bone remodeling outcomes in animal models, no significant efficacy was observed in the treatment of ONFH in the clinical studies. Further studies are required to solve the discordant outcomes between the animal and clinical studies.
Highlights
Osteonecrosis of the femoral head (ONFH) is a common debilitating disease that occurs in young and middle-aged adults[1,2]
Our results showed that bisphosphonate use significantly improved epiphyseal quotients (EQ) indicative of femoral head sphericity as well as better bone volume (BV), trabecular number (TN), trabecular separation, and trabecular thickness in the animal model
The BV, TN, trabecular thickness, and trabecular separation factors used to assess bone mass of the femoral head in the animal model were all significantly improved by bisphosphonate use, a finding that was very encouraging
Summary
Osteonecrosis of the femoral head (ONFH) is a common debilitating disease that occurs in young and middle-aged adults[1,2]. Bisphosphonates are a class of drugs that can bind to the bone and inhibit osteoclast activity by reducing bone resorption[9,10,11] They are usually used to treat diseases involving bone resorption progression, such as osteoporosis, Paget’s disease, and fibrous dysplasia[11,12,13]. A meta-analysis of a small number of clinical studies reported that the use of bisphosphonates cannot prevent femoral head collapse or delay total hip replacement after ONFH22. To evaluate the effect of bisphosphonates on preventing femoral head collapse after osteonecrosis, we identified all related animal studies and clinical trials from the electronic database and conducted this meta-analysis comprehensively to judge whether bisphosphonates should be recommended to ONFH patients and are worthy of further study
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