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Perioperative bisphosphonates may enhance functional outcomes and quality of life in fragility fracture patients while balancing fracture prevention and potential side effects.
Based on the data from 19 clinical trials involving 2,543 patients, the administration of bisphosphonates during the perioperative period was found to not only maintain healing processes but also improve outcomes for patients suffering from fragility fractures. Bisphosphonates have been previously shown to reduce the risk of subsequent fractures and promote functional recovery. However, the timing of treatment initiation for patients with fragility fractures remains debatable. To address this uncertainty, this meta-analysis issued in the “Osteoporosis International” journal compared the effects of bisphosphonate therapy during the perioperative phase with those initiated during non-perioperative periods.
Web of Science, EMBASE, PubMed, and the Cochrane Library were explored for research published before Feb 2023, without language limits. Primary outcomes focused on fracture healing rate, healing time, and new fractures. A random-effects meta-analysis was performed. No significant differences in fracture healing rates or times between patients who received bisphosphonates during the perioperative period and those who began treatment 4-6 weeks or 10-12 weeks post-surgery were found. Specifically, the risk ratios for healing rates were 1.06 (95% CI: 0.81, 1.38, p=0.69) and 1.02 (95% CI: 0.94, 1.11, p=0.65), respectively.
Healing time differed by just -0.19 weeks, showing no prominent effect of perioperative bisphosphonates initiation. Whereas in the case of new fractures, a markedly lower risk (overall risk ratio of 0.35 [95% CI: 0.17-0.73, p=0.005]) was observed compared to people who did not receive bisphosphonates, suggesting that bisphosphonates may provide a protective effect against new fractures. In terms of adverse events, a markedly higher likelihood of fever, arthralgia and myalgia were prevalent.
Osteoporosis International
The Healing and therapeutic effects of perioperative bisphosphonate use in patients with fragility fractures: meta-analysis of 19 clinical trials
Yuhong Zeng et al.
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