Bisphosphonate use prior to THA may be risk factor for periprosthetic fracture
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LAS VEGAS — Use of bisphosphonates prior to primary total hip arthroplasty may be an independent risk factor for periprosthetic fracture among patients with osteoporosis, according to results presented here.
“Our data suggests that cemented fixation may have a protective effect, though this wasn’t statistically significant with the numbers available,” Joseph Serino III, MD, said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting.
Serino and colleagues categorized 30,137 patients with osteoporosis undergoing THA into groups based on whether they were prescribed bisphosphonates, according to the abstract.
“Bisphosphonate users were defined as patients with a continuous prescription for bisphosphonates for at least 6 months preoperatively, which is criteria that has been previously established in the arthroplasty literature,” Serino said. “Bisphosphonate naïve patients had no bisphosphonate exposure during the study period.”
Serino noted patients using bisphosphonates were matched one-to-one with patients in the bisphosphonate naïve group based on age, sex, Elixhauser Comorbidity Index and a preoperative diagnosis of obesity, tobacco use, rheumatoid arthritis and alcohol use.
“These specific demographics and comorbidities were included in the matching algorithm because they’re among the greatest risk factors for fragility fractures in osteoporotic patients and are also key components to the World Health Organization’s Fracture Risk Assessment Tool,” Serino said.
Researchers compared 2-year outcomes between the matched groups and performed a subgroup analysis for cementless and cemented THA cohorts using fixation-specific ICD-10 procedure codes.
“The primary finding of our study was that bisphosphonate users experienced a significantly increased rate of periprosthetic fractures compared to bisphosphonate naïve patients,” Serino said.
However, he added the two groups had no significant differences in other 2-year outcomes, including periprosthetic joint infection, aseptic loosening, dislocation and mortality.
Although patients in the bisphosphonate group who underwent cementless THA trended toward increased rates of periprosthetic fractures, Serino noted patients in the bisphosphonate group who underwent cemented THA trended toward decreased rates of periprosthetic fractures, but these differences did not reach statistical significance.
“Bisphosphonate users undergoing cemented total hip arthroplasty also experienced a slightly lower rate of any revision compared to bisphosphonate naïve patients, although, again, this difference did not reach statistical significance,” Serino said.
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Della Valle CJ, et al. Paper 105. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 7-11, 2023; Las Vegas.
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