Association of Bisphosphonate Use and Risk of Revision After THA: Outcomes From a US Total Joint Replacement Registry
Association of Bisphosphonate Use and Risk of Revision After THA: Outcomes From a US Total Joint Replacement Registry
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DOI：
10.1007/s11999-015-4263-4
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发表时间：
2015-11-01
影响因子：
4.2
通讯作者：
Namba, Robert S.
中科院分区：
文献类型：
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作者：
Khatod, Monti;Inacio, Maria C. S.;Namba, Robert S.
全髋关节置换术（THA）通常在老年患者中进行，可能需要双膦酸盐来治疗各种疾病，最常见的是骨质疏松症。然而，双膦酸盐对接受THA的患者的临床效果还没有很好的描述。(1)与未接受双膦酸盐治疗的患者相比，接受初次THA的骨关节炎患者使用双膦酸盐是否与全因翻修、无菌翻修或假体周围骨折的风险变化相关？(2)双膦酸盐使用、翻修和假体周围骨折的风险是否因患者骨密度和年龄而异？对12，878例诊断为骨关节炎的THA接受者进行了回顾性队列研究; 17.8%的患者为双膦酸盐使用者。本研究的数据来源包括关节置换登记处（93%自愿参与）和电子健康记录以及骨质疏松症筛查数据库，该数据库作为Kaiser Permanente综合医疗保健系统的一部分完整采集病例。本研究的终点是任何原因的翻修手术、无菌翻修和假体周围骨折。关注的暴露是双膦酸盐使用;如果处方连续补充等于或长于6个月，则认为患者是使用者。骨质量（基于双能X射线吸收测定法，根据国家骨质疏松基金会的临床指南在THA后5年内进行）和患者年龄（< 65岁与每千日元65岁的部分）作为效果调节剂进行评价。将患者、外科医生和医院因素作为混杂因素进行评价。采用考克斯比例风险模型。双膦酸盐使用者的全因（HR，0.50; 95%CI，0.33-0.74; p < 0.001）和无菌翻修（HR，0.53; 95%CI，0.34-0.81; p = 0.004）的年龄和性别校正风险低于非使用者。接受双膦酸盐治疗的患者中假体周围骨折的调整后风险高于未接受双膦酸盐治疗的患者（HR，1.92; 95% CI，1.13-3.27; p = 0.016）。骨量减少患者的全因翻修和无菌翻修风险较低（HR，0.49; 95% CI，0.29-0.84; HR，0.53; 95% CI，0.29-0.99）和骨质疏松症（HR，0.22; 95%CI，0.08-0.62; HR，0.33; 95%CI，0.11-0.99）。接受THA的患者认为双膦酸盐使用者翻修手术的风险较低。在骨量正常的年轻患者中，使用双膦酸盐与假体周围骨折的风险较高相关。骨质量评价和双膦酸盐用于诊断骨质疏松症的骨关节炎患者谁是初次THA的候选人鼓励。由于长期使用双膦酸盐与非典型股骨骨折相关，需要进一步研究以确定最佳治疗时间。III级，治疗研究。
Total hip arthroplasty (THA) is often performed in patients who are older and may take bisphosphonates to treat a variety of conditions, most commonly osteoporosis. However, the clinical effects of bisphosphonate use on patients who have undergone THA are not well described.(1) Is bisphosphonate use in patients with osteoarthritis undergoing primary THA associated with a change in the risk of all-cause revision, aseptic revision, or periprosthetic fracture compared with patients not treated with bisphosphonates? (2) Does the risk of bisphosphonate use and revision and periprosthetic fracture vary by patient bone mineral density and age?A retrospective cohort study of 12,878 THA recipients for the diagnosis of osteoarthritis was conducted; 17.8% of patients were bisphosphonate users. Data sources for this study included a joint replacement registry (93% voluntary participation) and electronic health records and an osteoporosis screening database with complete capture of cases as part of the Kaiser Permanente integrated healthcare system. The endpoints for this study were revision surgery for any cause, aseptic revision, and periprosthetic fracture. The exposure of interest was bisphosphonate use; patients were considered users if prescriptions were continuously refilled for a period equal to or longer than 6 months. Bone quality (based on dual-energy x-ray absorptiometery ordered based on the National Osteoporosis Foundation's clinical guidelines taken within 5 years of the THA) and patient age (< 65 versus a parts per thousand yen 65 years) were evaluated as effect modifiers. Patient, surgeon, and hospital factors were evaluated as confounders. Cox proportional hazards models were used. Hazard ratios (HRs) and 95% confidence intervals (CIs) were determined.Age- and sex-adjusted risks of all-cause (HR, 0.50; 95% CI, 0.33-0.74; p < 0.001) and aseptic revision (HR, 0.53; 95% CI, 0.34-0.81; p = 0.004) was lower in bisphosphonate users than in nonusers. The adjusted risk of periprosthetic fractures in patients on bisphosphonates was higher than in patients not on bisphosphonates (HR, 1.92; 95% CI, 1.13-3.27; p = 0.016). Lower risks of all-cause revision and aseptic revision were observed in patients with osteopenia (HR, 0.49; 95% CI, 0.29-0.84; and HR, 0.53; 95% CI, 0.29-0.99, respectively) and osteoporosis (HR, 0.22; 95% CI, 0.08-0.62; and HR, 0.33; 95% CI, 0.11-0.99, respectively).Patients considered bisphosphonate users who underwent THA had a lower risk for revision surgery. Bisphosphonate use was associated with a higher risk of periprosthetic fractures in younger patients with normal bone quantity. Evaluation of bone quality and bisphosphonate use for the diagnosis of osteoporosis is encouraged in patients with osteoarthritis who are candidates for primary THA. Further research is required to determine the optimal duration of therapy because long-term bisphosphonate use has been associated with atypical femur fractures.Level III, therapeutic study.