The effects of bisphosphonates on osteoporotic patients after lumbar fusion: a meta-analysis.

Abstract

PurposeWe conducted a meta-analysis of controlled clinical trials to evaluate the efficacy of bisphosphonates in lumbar fusion.IntroductionBisphosphonates reduce bone resorption and remodeling by osteoclast activity inhibition, inactivation, and apoptosis. However, it remains controversial whether bisphosphonate therapy affects spinal fusion.MethodsWe searched MEDLINE, Cochrane CENTRAL, ScienceDirect, EMBASE, and Google Scholar to identify studies reporting the effects of bisphosphonates on osteoporotic patients after lumbar fusion. Secondary sources were identified from the references of the included literature. Pooled data were analyzed using RevMan 5.1.ResultsSeven studies met the inclusion criteria. There were significant differences in solid intervertebral fusion (RD=0.07, 95% CI: −0.00 to 0.15, P=0.05), subsequent VCFs (RD=−0.21, 95% CI: −0.30 to −0.12, P<0.00001), pedicle screw loosening (RD=−0.17, 95% CI: −0.28 to −0.05, P=0.006), and cage subsidence (RD=−0.25, 95% CI: −0.42 to −0.07, P=0.005) between two groups. No significant differences between two groups were found regarding implant fixation failure (RD=−0.06, 95% CI: −0.22 to 0.10, P=0.48).ConclusionThis meta-analysis showed that bisphosphonates may increase solid intervertebral fusion and decrease subsequent VCFs, pedicle screw loosening, and cage subsidence.