ORIGINAL RESEARCH article
Front. Pharmacol.
Sec. Pharmacogenetics and Pharmacogenomics
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1566890
Effectiveness of Treatments to Prevent Femoral Periprosthetic Bone Loss in People Following Total Hip Arthroplasty: A Network Meta-analysis
Provisionally accepted
- 1Tianjin Hospital, Tianjin, China
- 2Suqian First People's Hospital, Suqian, Jiangsu Province, China
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Background: The objective of this study was to conduct a systematic review and network meta-analysis (NMA) to compare the efficacy of various anti-osteoporosis drugs in preventing femoral periprosthetic bone loss following total hip arthroplasty (THA). Methodology: Randomized controlled trials (RCTs) assessing the clinical efficacy of various anti-osteoporosis drugs and control treatments in preventing periprosthetic bone loss following THA were identified. Outcomes evaluated included bone mineral density (BMD) at 6, 12, and 24 months, as well as 5-10 years. Network meta-analysis was conducted using Stata 13.0 and R-3.5.1 software with the "gemtc" package. Results: A total of 33 RCTs with 1169 patients were included. At 6 months, Alendronate, Alendronate+Alfacalcidol, Denosumab, Ibandronate, Raloxifene, Teriparatide+Alendronate, and Zoledronic acid were beneficial in increasing BMD, with Denosumab ranking highest (based on SUCRA values). At 12 months, Alendronate, Alendronate+Alfacalcidol, Denosumab, Ibandronate, Risedronate, and Zoledronic acid showed benefits, with Alendronate+Alfacalcidol ranking highest (SUCRA=0.97). For 24-month BMD, Teriparatide+Alendronate ranked highest (SUCRA=0.82). Analysis of BMD at 5-10 years, involving four studies on Alendronate, Pamidronate, and placebo, indicated that Alendronate achieved the highest SUCRA value (0.87). Conclusion: Both Denosumab and Bisphosphonates are effective in preventing femoral periprosthetic bone loss following THA. Denosumab was the most efficient agent for increasing BMD at 6 months post-THA, while Alendronate combined with Alfacalcidol or Teriparatide was most efficient at 12 and 24 months. More high-quality direct comparisons and long-term follow-up studies are needed to determine the optimal drug and dosage for THA patients.
Keywords: Total hip arthroplasty, Meta-analysis, bone mineral density, network, Anti-osteoporosis
Received: 26 Jan 2025; Accepted: 09 Oct 2025.
Copyright: © 2025 Zhao, Ling, Zhao, Luo, Ma and Ma. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Zhihu Zhao, gukezzh@126.com
Xinlong Ma, y2461013@tju.edu.cn
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