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The effects of bisphosphonates on osteoporotic patients after lumbar fusion: a meta-analysis

Authors Liu WB, Zhao WT, Shen P, Zhang FJ

Received 4 February 2018

Accepted for publication 8 May 2018

Published 17 July 2018 Volume 2018:12 Pages 2233—2240


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Georgios D. Panos

Wen-bin Liu,1,* Wen-tao Zhao,2,* Peng Shen,3 Fu-jiang Zhang1

1Department of Joint Surgery, Tianjin Hospital, Tianjin 300211, People’s Republic of China; 2Department of Orthopedics, The First Affiliated Hospital of Yunnan Traditional Chinese Medical University, Yunnan 650021, People’s Republic of China; 3Department of Rheumatology and Immunology, Tianjin First Center Hospital, Tianjin 300192, People’s Republic of China

*These authors contributed equally to this work

Purpose: We conducted a meta-analysis of controlled clinical trials to evaluate the efficacy of bisphosphonates in lumbar fusion.
Introduction: Bisphosphonates reduce bone resorption and remodeling by osteoclast activity inhibition, inactivation, and apoptosis. However, it remains controversial whether bisphosphonate therapy affects spinal fusion.
Methods: We searched MEDLINE, Cochrane CENTRAL, ScienceDirect, EMBASE, and Google Scholar to identify studies reporting the effects of bisphosphonates on osteoporotic patients after lumbar fusion. Secondary sources were identified from the references of the included literature. Pooled data were analyzed using RevMan 5.1.
Results: Seven studies met the inclusion criteria. There were significant differences in solid intervertebral fusion (RD=0.07, 95% CI: −0.00 to 0.15, P=0.05), subsequent VCFs (RD=−0.21, 95% CI: −0.30 to −0.12, P<0.00001), pedicle screw loosening (RD=−0.17, 95% CI: −0.28 to −0.05, P=0.006), and cage subsidence (RD=−0.25, 95% CI: −0.42 to −0.07, P=0.005) between two groups. No significant differences between two groups were found regarding implant fixation failure (RD=−0.06, 95% CI: −0.22 to 0.10, P=0.48).
Conclusion: This meta-analysis showed that bisphosphonates may increase solid intervertebral fusion and decrease subsequent VCFs, pedicle screw loosening, and cage subsidence.

Keywords: bisphosphonates, lumbar, fusion, meta-analysis

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