Abstract | INTRODUCTION: Atypical periprosthetic/ peri-implant fractures are not recognised in any widely used classification and therefore little focus is given to them. Multiple case reports and case series demonstrate these fractures exist and are related to bisphosphonate (BP) use. HYPOTHESIS: Are patients taking long-term BPs at an increased risk of developing an atypical periprosthetic/ peri-implant fracture? Is a particular BP drug causing an increased risk of fracture? Is there a correlation between the time of BP use and the incidence of fractures? Do vitamin D analogues or parathyroid hormones reduce the time to union? MATERIAL AND METHODS: Systematic review of all available evidence on the existence of periprosthetic/peri-implant atypical fractures in patients taking long-term BPs and metanalysis of available retrospective cohort studies. Selected 1 systematic review, 7 retrospective cohort studies (5 used for metanalysis) and 32 case reports. RESULTS: Metanalysis reported a risk ratio of 14.1, p=0.25, suggesting bisphosphonates are a risk factor in the development of periprosthetic/peri-implant atypical fractures. The secondary outcomes couldn't be reliably identified due to the small size of available studies and risk of significant bias. DISCUSSION: LEVEL OF EVIDENCE: II, Systematic review and metanalysis.
|
Authors | Pedro Ferreira, Peter Bates, Ahmed Daoub, Debashis Dass |
Journal | Orthopaedics & traumatology, surgery & research : OTSR
(Orthop Traumatol Surg Res)
Vol. 109
Issue 2
Pg. 103475
(04 2023)
ISSN: 1877-0568 [Electronic] France |
PMID | 36347461
(Publication Type: Journal Article, Meta-Analysis, Systematic Review)
|
Copyright | Copyright © 2022 Elsevier Masson SAS. All rights reserved. |
Chemical References |
|
Topics |
- Humans
- Diphosphonates
(adverse effects)
- Femoral Fractures
- Periprosthetic Fractures
(chemically induced, epidemiology)
- Retrospective Studies
- Risk Factors
|