Journal ArticleDOI
Bisphosphonate use and risk of post-operative fracture among patients undergoing a total knee replacement for knee osteoarthritis: a propensity score analysis.
Daniel Prieto-Alhambra,Muhammad Javaid,Andrew Judge,J Maskell,J Maskell,Amit Kiran,Cyrus Cooper,Cyrus Cooper,Nigel K Arden,Nigel K Arden,Nigel K Arden +10 more
Reads0
Chats0
TLDR
It is suggested that BPU in primary prevention could reduce post-operative risk of fracture by 50% and by 55% in secondary prevention.Abstract:
We have shown that patients with osteoarthritis are at increased risk of fracture after total knee replacement (TKR). We conducted a population-based cohort study to assess the effect of bisphosphonate use on their post-surgery fracture risk. Cox regression adjusted by propensity score suggested a 50–55% reduction in risk of fracture post-surgery. Patients with osteoarthritis have a higher bone mass but similar or higher risk of fracture. We recently demonstrated that patients have an elevated fracture risk after TKR, but it is unknown if bisphosphonate therapy in this patient group would reduce fracture risk. We aimed to assess the effect of bisphosphonate prescription to patients undergoing a TKR, on their risk of fracture after surgery. From the General Practice Research Database, all patients ≥ 40 years old, who received a TKR from 1986 to 2006 for knee osteoarthritis were eligible. We identified bisphosphonate use (BPU) as the main exposure. Propensity scores (equivalent to the estimated conditional probability of being treated given the individual's covariates) were calculated using logistic regression and used to reduce observed confounding. We fitted Cox models to study the effect of BPU on post-surgery fracture occurrence. Analyses were stratified by history of previous fracture: no fracture, osteoporotic fracture (hip, wrist, humerus, spine), and other fractures. The hazard ratio (HR) associated with BPU in non-previously fractured patients was 0.50 (95% confidence interval, 0.37–0.68; propensity-adjusted model), and 0.48 (0.35–0.65; matched analysis). In subjects with osteoporotic and with other previous fracture, BPU was associated with a propensity-adjusted HR of 0.46 (0.30 to 0.71) and 0.47 (0.26–0.85), respectively, and with a propensity-matched HR of 0.45 (0.29 to 0.70) and 0.45 (0.25–0.82). Our results suggest that BPU in primary prevention could reduce post-operative risk of fracture by 50% and by 55% in secondary prevention.read more
Citations
More filters
Journal ArticleDOI
Morbidity and Mortality After Vertebral Fractures: Comparison of Vertebral Augmentation and Nonoperative Management in the Medicare Population.
TL;DR: VCF patients in the Medicare population who received vertebral augmentation therapies, specifically BKP and VP, experienced lower mortality and overall morbidity than VCF patients who received conservative management.
Journal ArticleDOI
Association between bisphosphonate use and implant survival after primary total arthroplasty of the knee or hip: population based retrospective cohort study.
Daniel Prieto-Alhambra,Muhammad Javaid,Andrew Judge,David W. Murray,Andrew Carr,Cyrus Cooper,Nigel K Arden +6 more
TL;DR: In patients undergoing lower limb arthroplasty, bisphosphonate use was associated with an almost twofold increase in implant survival time and these findings require replication and testing in experimental studies for confirmation.
Journal ArticleDOI
Osteoporosis and Orthopedic Surgery: Effect of Bone Health on Total Joint Arthroplasty Outcome
TL;DR: Focusing on bone health perioperatively should result in better outcomes for orthopedic procedures, and both bisphosphonates and teriparatide may aide successful osteointegration among patients undergoing noncemented joint arthroplasty.
Journal ArticleDOI
Effect of bisphosphonates on knee replacement surgery.
TL;DR: In this population-based cohort of older women with incident knee OA, those with incident bisphosphonate users had lower risk of KR than non-users of bisph phosphonates, suggesting a potential beneficial effect of bis phosphonates on knees OA.
Journal ArticleDOI
Lower limb arthroplasty: can we produce a tool to predict outcome and failure, and is it cost-effective? An epidemiological study
Nigel K Arden,Doug G Altman,David J Beard,Andrew Carr,Nicholas Clarke,Gary S. Collins,Cyrus Cooper,David Culliford,Antonella Delmestri,Stefanie Garden,Tinatin Griffin,Kassim Javaid,Andrew Judge,Latham Jm,Mark Mullee,David W. Murray,Emmanuel O. Ogundimu,Rafael Pinedo-Villanueva,Andrew Price,Daniel Prieto-Alhambra,James Raftery +20 more
TL;DR: The strongest predictors for poor outcomes were preoperative pain/function scores, deprivation, age, mental health score and radiographic variable pattern of joint space narrowing and osteoarthritis severity and migration pattern of the hip predicted patient-reported outcome measures.
References
More filters
Journal ArticleDOI
The central role of the propensity score in observational studies for causal effects
TL;DR: The authors discusses the central role of propensity scores and balancing scores in the analysis of observational studies and shows that adjustment for the scalar propensity score is sufficient to remove bias due to all observed covariates.
Journal ArticleDOI
Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial
Bruce Ettinger,Dennis M. Black,Bruce H. Mitlak,Ronald Keith Knickerbocker,Thomas Nickelsen,Harry K. Genant,Claus Christiansen,Pierre D. Delmas,Jose R. Zanchetta,J. A. Stakkestad,Claus C. Glüer,Kathryn A. Krueger,Fredric J. Cohen,Stephen Eckert,Kristine E. Ensrud,Louis V. Avioli,Paul Lips,Steven R. Cummings +17 more
TL;DR: The Multiple Outcomes of Raloxifene Evaluation (MORE) study as mentioned in this paper evaluated the effect of raloxion hydrochloride therapy on risk of vertebral and non-vertebral fractures.
Journal ArticleDOI
Hip fractures in the elderly: A world-wide projection
TL;DR: In this article, the authors applied available incidence rates for hip fracture from various parts of the world to projected populations in 1990, 2025 and 2050 in order to estimate the numbers of hip fractures which might occur in each of the major continental regions.
Journal ArticleDOI
Effects of Risedronate Treatment on Vertebral and Nonvertebral Fractures in Women With Postmenopausal Osteoporosis: A Randomized Controlled Trial
Steven T. Harris,Nelson B. Watts,Harry K. Genant,Clark D. McKeever,Thomas N. Hangartner,Michael Keller,Charles H. Chesnut,Jacques P. Brown,Erik Fink Eriksen,Mohammad S. Hoseyni,Douglas Wayne Axelrod,Paul D. Miller +11 more
TL;DR: Risedronate, a potent bisphosphonate, has been shown to be effective in the treatment of Paget disease of bone and other metabolic bone diseases, but, to the knowledge, it has not been evaluated in this article.
Hip fractures in the elderly: a worldwide projection
C Cooper,G. Campion,L. J. Melton +2 more
TL;DR: The results suggest that osteoporosis will truly become a global problem over the next half century, and that preventive strategies will be required in parts of the world where they are not currently felt to be necessary.