title: Effect of bisphosphonates in preventing femoral periprosthetic bone resorption after primary cementless total hip arthroplasty: a meta-analysis.
abstract: BACKGROUND
  Bone loss leading to aseptic loosening of the prosthesis and periprosthetic fracture is a mode of failure in cementless total hip arthroplasty (THA). The aim of this meta-analysis was to evaluate the effect of bisphosphonates in preventing femoral periprosthetic bone resorption following primary cementless THA zone by zone.
  
  
  METHODS
  Clinical randomized controlled trials concerning bisphosphonates application after primary cementless THA published up to October 2014 were retrieved from PubMed, Cochrane library, and Embase databases. The methodological quality of the included studies was assessed by the Physiotherapy Evidence Database (PEDro) scale. Data analysis was performed using StataSE12.0.
  
  
  RESULTS
  Ten randomized controlled trials involving a total of 502 patients were assessed; the bisphosphonates group included 256 patients and the control group included 246 patients. The meta-analysis showed that the bone mineral density (BMD) of most femoral periprosthetic zones in bisphosphonates group was significantly higher than that in the control group at 3 months postoperatively except zone 5 with no significant difference. At 6 and 12 months, the BMD of bisphosphonates group was much higher than that in control group except zone 5, which showed no statistical difference. The BMD of bisphosphonates group was persistently higher than control group in zone 6 and 7 at 5 years postoperatively, while the other zones had no significant difference. Both serum bone alkaline phosphatase and urinary type I collagen N-telopeptide were significantly suppressed by bisphosphonates at 3, 6, and 12 months.
  
  
  CONCLUSIONS
  Bisphosphonates seem to decrease early femoral periprosthetic bone resorption after primary cementless THA. Drug efficacy was found to be long-standing in the main load-bearing zones.
authors.affiliation: Department of Orthopaedics, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei Province, 430071, China. 478252553@qq.com.
authors.forename: Xinyu
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Orthopaedics, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei Province, 430071, China. hudongcai11@163.com.
authors.forename: Dongcai
authors.initials: D
authors.lastname: Hu
authors.affiliation: Department of Orthopaedics, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei Province, 430071, China. 757599061@qq.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Qin
authors.affiliation: Department of Orthopaedics, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei Province, 430071, China. 860136551@qq.com.
authors.forename: Rahul
authors.initials: R
authors.lastname: Mohanan
authors.affiliation: Department of Orthopaedics, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei Province, 430071, China. lbchen@whu.edu.cn.
authors.forename: Liaobin
authors.initials: L
authors.lastname: Chen
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001862:Bone Resorption / Q000517:prevention & control*; D004164:Diphosphonates / Q000627:therapeutic use*; D005270:Femur Head / Q000187:drug effects; D006622:Hip Prosthesis / Q000009:adverse effects; D006801:Humans; D011475:Prosthesis Failure / Q000187:drug effects*
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates