Bisphosphonates do not reduce joint failure or THA in femoral head osteonecrosis patients

Study Type: Meta analysis
OE Level of Evidence: 1
Journal Level of Evidence: N/A
5 randomized controlled trials investigating the benefits of bisphosphonate therapy in the treatment of femoral head osteonecrosis were included in this meta-analysis. The purpose of this study was to determine whether bisphosphonate treatment should be recommended to patients suffering from this condition. The findings of Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Non-Industry funded
Sponsor: National Natural Science Foundation of China and Major Program for the Fundamental Research of Shanghai
Conflicts: None disclosed
Why was this study needed now?
Osteonecrosis of the femoral head is the cause of considerable pain in affected individuals and is suggested to be the result of an imbalanced bone metabolism specific to bone resorption exceeding bone formation. In theory, bisphosphonates are suggested to inhibit resorption while adequate bone is formed in order to avoid the eventual joint failure. However, there is conflicting evidence regarding their effect on clinically important outcomes such as reducing disease progression, preventing total hip arthroplasty (THA), or in improving the quality of life in patients with osteonecrosis of the femoral head. As such, the present analysis aimed to decipher whether bisphosphonates should be recommended clinically in femoral head osteonecrosis via systematic review and meta-analysis.
What was the principal research question?
Was the administration of bisphosphonates in femoral head osteonecrosis successful in preventing progression of the disease and joint failure?
Data Source: An online search of PubMed, Embase, and Web of Science was conducted from inception to July 2015. A manual search was done of the reference lists of included studies to identify any additional literature.
Index Terms: The search terms included "bisphosphonate," "osteonecrosis" or "avascular necrosis," and "femoral head" or "femur."
Study Selection: Randomized controlled trials published in English were included if they had bisphosphonate therapy as an intervention, a placebo or control group, a minimum follow-up of 2 years, and one of progression to collapse, total hip arthroplasty incidence, or Harris Hip Score (HHS), as an outcome. Two authors independently reviewed the searched articles for eligibility. 5 randomized control trials (n=329 patients), all of level 1 evidence, were selected for final inclusion. Of these studies, four used alendronate while one used zoledronate.
Data Extraction: Data extraction was standardized and if specific information was not available, authors were contacted in order to obtain missing data.
Data Synthesis: STATA version 11.0 (Stata Corporation, USA) and Review Manager version 5.0 (The Cochrane Collaboration, UK) were used to analyze data in this meta-analysis. Data was reported as a pooled risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI). The I2 statistic was used to determine heterogeneity, with a value of >50% being considered significant. Publication bias was assessed using Begg's regression model funnel plot, and the 1-study removed method was used for sensitivity analyses. P values of <0.05 were indicative of significant outcomes.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.