title: Bisphosphonate Use and Risk of Implant Revision after Total Hip/Knee Arthroplasty: A Meta-Analysis of Observational Studies.
abstract: OBJECTIVE
  Several studies investigated the association between bisphosphonate use and the risk of implant revision after total hip or knee arthroplasty (THA or TKA); However, the findings were inconsistent. We performed this meta-analysis to evaluate the overall relative risk of such an event.
  
  
  METHODS
  We searched the PubMed, EMBASE and Cochrane library databases to identify relevant publications on April 22, 2015. To calculate the pooled risk ratios (RRs) with 95% confidential intervals (CIs), a fixed- or random-effects model was applied based on the heterogeneity across studies.
  
  
  RESULTS
  Three cohort studies and one case-control study were included in this meta-analysis. Compared with the bisphosphonate nonusers, the patients who used bisphosphonates for a long period of time had a significantly decreased risk of implant revision after THA/TKA (summary adjusted RR = 0.48, 95% CI: 0.38-0.61), and the summary adjusted RRs for the users who underwent THA and those who underwent TKA were 0.47 (95% CI: 0.36-0.61) and 0.45 (95% CI: 0.21-0.95), respectively.
  
  
  CONCLUSIONS
  Long-term use of bisphosphonates is correlated with a significantly decreased risk of implant revision after THA/TKA. However, due to limited number of the included studies, the findings of the present study should be treated with caution. More well-designed studies are required to further confirm our findings.
authors.affiliation: Department of Orthopedics, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, P. R. China; Department of Orthopedic Trauma, Hannover Medical School, Hanover, Germany.
authors.forename: Songsong
authors.initials: S
authors.lastname: Teng
authors.affiliation: Department of Orthopedics, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, P. R. China.
authors.forename: Chengqing
authors.initials: C
authors.lastname: Yi
authors.affiliation: Department of Orthopedic Trauma, Hannover Medical School, Hanover, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Krettek
authors.affiliation: Department of Orthopedic Trauma, Agaplesion ev. Hospital Bethel, Bückeburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Jagodzinski
mesh_terms: D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D050071:Bone Density Conservation Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004164:Diphosphonates / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D064887:Observational Studies as Topic; D011475:Prosthesis Failure / Q000187:drug effects*; D012086:Reoperation / Q000706:statistics & numerical data*; D012307:Risk Factors
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates