Zoledronic acid and denosumab for periprosthetic bone mineral density loss after joint arthroplasty: a systematic review and meta-analysis of randomized controlled trials.

Abstract

Periprosthetic bone mineral density (BMD) loss after total hip arthroplasty (THA) may threaten the survival of implants. Zoledronic acid (ZA) and denosumab were effective in reducing bone loss in conditions associated with accelerated bone turnover by inhibiting osteoclast activity. This meta-analysis aimed to assess the efficiency and safety of ZA and denosumab for periprosthetic BMD loss after THA. A systematic search of randomized controlled trials (RCTs) associated with ZA or denosumab and THA was performed in MEDLINE, PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the Web of Science from 1980 to 2022. Meta-analysis was performed by the Cochrane Review Manager 5 (RevMan) version 5.41. Cochrane risk of bias tool and GRADEpro were applied for methodological quality and overall evidence quality, respectively. Nine RCTs involving a total of 480 patients were finally included and analyzed. The pooled data that demonstrated significantly less periprosthetic BMD lossin Gruen zone 7 occurred in the intervention group patients than in the control group patients at 3months (MD = 4.30, 95%CI: 1.78-6.82,P = 0.0008), 6months (MD = 7.71, 95%CI: 5.41-10.02,P < 0.00001), and 12months (MD = 8.19, 95%CI: 5.97-10.42,P < 0.00001) after THA. No serious adverse events (AEs) were observed. In the current analysis with evidence on the efficacy and safety of ZA and denosumab, the authors recommend the use of ZA or denosumab treatment for periprosthetic bone mineral density loss. PROSPERO registration number: CRD42022369273.