Top

Archives of Orthopaedic and Trauma Surgery

Published in:

13-03-2021 | Zoledronic Acid | Orthopaedic Surgery

Effectiveness and safety of percutaneous kyphoplasty combined with zoledronic acid in treatment of osteoporotic vertebral compression fractures: a meta-analysis

Authors: Min Zhuang, Bin Cai, Fanfan Wang

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 10/2022

Abstract

Introduction

To investigate the clinical effectiveness of combination treatment of percutaneous kyphoplasty (PKP) and zoledronic acid (ZOL) in the treatment of osteoporotic vertebral compression fracture (OVCF).

Materials and methods

We searched studies investigating the PKP combined with ZOL in the treatment of OVCF. We used a fixed-effects or random-effects model to analyze the bone mineral density (BMD), visual analogue scale (VAS), Oswestry disability index (ODI), bone markers (N-MID, β-CTX, and P1NP) and adverse events, expressed as weight mean difference (WMD) and risk ratio (RR) with 95% confidence interval (95% CI).

Results

We identified 5 cohort studies with a total of 440 patients. Compared with PKP alone, the combination treatment of PKP and ZOL significantly reduced the VAS score at 6 months (WMD = − 0.78, 95% CI − 1.42, − 0.14; P = 0.018), and 12 months (WMD = − 0.98, 95% CI − 1.46, − 0.51; P < 0.001). Moreover, the combination treatment also improved the BMD at 6 (WMD = 0.06, 95% CI 0.01, 0.11, P = 0.016) and 12 months (WMD = 0.20, 95% CI 0.03, 0.36, P = 0.018) after treatment. The ODI score in the combination group was significantly lower than in PKP group at 6, 12 and 24 months after treatment (at 6 months: WMD = − 9.25, 95% CI − 13.62, − 4.87 P < 0.001; at 12 months: WMD = − 9.21, 95% CI − 11.91, − 6.50, P < 0.001; at 24 months: WMD = − 7.26, 95% CI − 11.39, − 3.14, P = 0.001). The N-MID and P1NP values were found to be significantly lower in the combination group than the PKP group, but the β-CTX value was similar between the two groups. There was no significant difference in incidence of adverse events between the two groups, but more adjacent vertebral fractures and bone cement leakage occurred in PKP alone group.

Conclusion

In patients with OVCF, combination treatment of PKP and ZOL showed more effective than PKP alone in improving BMD and bone marker levels, relieving pain, as well as reducing the risk of new fractures. More large-scale RCTs are needed to verify our findings.

de Bekker-Grob EW, Essink-Bot ML, Meerding WJ, Pols HA, Koes BW, Steyerberg EW (2008) Patients’ preferences for osteoporosis drug treatment: a discrete choice experiment. Osteoporos Int 19(7):1029–1037. https://doi.org/10.1007/s00198-007-0535-5CrossRefPubMedPubMedCentral

Bone HG, Wagman RB, Brandi ML, Brown JP, Chapurlat R, Cummings SR, Czerwiński E, Fahrleitner-Pammer A, Kendler DL, Lippuner K, Reginster JY, Roux C, Malouf J, Bradley MN, Daizadeh NS, Wang A, Dakin P, Pannacciulli N, Dempster DW, Papapoulos S (2017) 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol 5(7):513–523. https://doi.org/10.1016/s2213-8587(17)30138-9CrossRefPubMed

Ballane G, Cauley JA, Luckey MM, El-Hajj Fuleihan G (2017) Worldwide prevalence and incidence of osteoporotic vertebral fractures. Osteoporos Int 28(5):1531–1542. https://doi.org/10.1007/s00198-017-3909-3CrossRefPubMed

Belhassen M, Confavreux CB, Cortet B, Lamezec L, Ginoux M, Van Ganse E (2017) Anti-osteoporotic treatments in France: initiation, persistence and switches over 6 years of follow-up. Osteoporos Int 28(3):853–862. https://doi.org/10.1007/s00198-016-3789-yCrossRefPubMed

Viswanathan M, Reddy S, Berkman N, Cullen K, Middleton JC, Nicholson WK, Kahwati LC (2018) Screening to prevent osteoporotic fractures: updated evidence report and systematic review for the US preventive services task force. JAMA 319(24):2532–2551. https://doi.org/10.1001/jama.2018.6537CrossRefPubMed

Yu CW, Hsieh MK, Chen LH, Niu CC, Fu TS, Lai PL, Chen WJ, Chen WC, Lu ML (2014) Percutaneous balloon kyphoplasty for the treatment of vertebral compression fractures. BMC Surg 14:3. https://doi.org/10.1186/1471-2482-14-3CrossRefPubMedPubMedCentral

Zhao G, Liu X, Li F (2016) Balloon kyphoplasty versus percutaneous vertebroplasty for treatment of osteoporotic vertebral compression fractures (OVCFs). Osteoporos Int 27(9):2823–2834. https://doi.org/10.1007/s00198-016-3610-yCrossRefPubMed

Kim YY, Rhyu KW (2010) Recompression of vertebral body after balloon kyphoplasty for osteoporotic vertebral compression fracture. Eur Spine J 19(11):1907–1912. https://doi.org/10.1007/s00586-010-1479-6CrossRefPubMedPubMedCentral

Yi X, Lu H, Tian F, Wang Y, Li C, Liu H, Liu X, Li H (2014) Recompression in new levels after percutaneous vertebroplasty and kyphoplasty compared with conservative treatment. Arch Orthop Trauma Surg 134(1):21–30. https://doi.org/10.1007/s00402-013-1886-3CrossRefPubMed

10.

Wang E, Yi H, Wang M, Huang C (2013) Treatment of osteoporotic vertebral compression fractures with percutaneous kyphoplasty: a report of 196 cases. Eur J Orthopaed Surg Traumatol 23(Suppl 1):S71-75. https://doi.org/10.1007/s00590-013-1187-0CrossRef

11.

Tella SH, Gallagher JC (2014) Prevention and treatment of postmenopausal osteoporosis. J Steroid Biochem Mol Biol 142:155–170. https://doi.org/10.1016/j.jsbmb.2013.09.008CrossRefPubMed

12.

Dhillon S (2016) Zoledronic acid (Reclast(®), Aclasta(®)): a review in osteoporosis. Drugs 76(17):1683–1697. https://doi.org/10.1007/s40265-016-0662-4CrossRefPubMed

13.

Maricic M (2010) The role of zoledronic acid in the management of osteoporosis. Clin Rheumatol 29(10):1079–1084. https://doi.org/10.1007/s10067-010-1486-3CrossRefPubMed

14.

Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ (Clinical research ed) 339:b2535. https://doi.org/10.1136/bmj.b2535CrossRef

15.

Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25(9):603–605. https://doi.org/10.1007/s10654-010-9491-zCrossRefPubMed

16.

Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ (Clinical research ed) 327(7414):557–560. https://doi.org/10.1136/bmj.327.7414.557CrossRef

17.

DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188CrossRef

18.

Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22(4):719–748PubMed

19.

Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101CrossRef

20.

Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical research ed) 315(7109):629–634CrossRef

21.

Huang ZF, Xiao SX, Liu K, Xiong W (2019) Effectiveness analysis of percutaneous kyphoplasty combined with zoledronic acid in treatment of primary osteoporotic vertebral compression fractures. Pain Physician 22(1):63–68PubMed

22.

Liu B, Gan F, Ge Y, Yu H (2018) Clinical efficacy analysis of percutaneous kyphoplasty combined with zoledronic acid in the treatment and prevention of osteoporotic vertebral compression fractures. J Investig Surg 31(5):425–430. https://doi.org/10.1080/08941939.2017.1339151CrossRef

23.

Huang S, Zhu X, Xiao D, Zhuang J, Liang G, Liang C, Zheng X, Ke Y, Chang Y (2019) Therapeutic effect of percutaneous kyphoplasty combined with anti-osteoporosis drug on postmenopausal women with osteoporotic vertebral compression fracture and analysis of postoperative bone cement leakage risk factors: a retrospective cohort study. J Orthopaed Surg Res 14(1):452. https://doi.org/10.1186/s13018-019-1499-9CrossRef

24.

Shi C, Zhang M, Cheng AY, Huang ZF (2018) Percutaneous kyphoplasty combined with zoledronic acid infusion in the treatment of osteoporotic thoracolumbar fractures in the elderly. Clin Interv Aging 13:853–861. https://doi.org/10.2147/cia.s146871CrossRefPubMedPubMedCentral

25.

Zhang J, Zhang T, Xu X, Cai Q, Zhao D (2019) Zoledronic acid combined with percutaneous kyphoplasty in the treatment of osteoporotic compression fracture in a single T12 or L1 vertebral body in postmenopausal women. Osteoporos Int 30(7):1475–1480. https://doi.org/10.1007/s00198-019-04896-wCrossRefPubMed

26.

Zuo XH, Zhu XP, Bao HG, Xu CJ, Chen H, Gao XZ, Zhang QX (2018) Network meta-analysis of percutaneous vertebroplasty, percutaneous kyphoplasty, nerve block, and conservative treatment for nonsurgery options of acute/subacute and chronic osteoporotic vertebral compression fractures (OVCFs) in short-term and long-term effects. Medicine 97(29):e11544. https://doi.org/10.1097/md.0000000000011544CrossRefPubMedPubMedCentral

27.

Dempster DW, Roschger P, Misof BM, Zhou H, Paschalis EP, Alam J, Ruff VA, Klaushofer K, Taylor KA (2016) Differential effects of teriparatide and zoledronic acid on bone mineralization density distribution at 6 and 24 months in the SHOTZ study. J Bone Mineral Res 31(8):1527–1535. https://doi.org/10.1002/jbmr.2825CrossRef

28.

Berlemann U, Ferguson SJ, Nolte LP, Heini PF (2002) Adjacent vertebral failure after vertebroplasty. A biomechanical investigation. J Bone Joint Surg Br 84(5):748–752. https://doi.org/10.1302/0301-620x.84b5.11841CrossRefPubMed

29.

Craig SJ, Youssef PP, Vaile JH, Sullivan L, Bleasel JF (2011) Intravenous zoledronic acid and oral alendronate in patients with a low trauma fracture: experience from an osteoporosis clinic. Intern Med J 41(2):186–190. https://doi.org/10.1111/j.1445-5994.2010.02198.xCrossRefPubMed

30.

Liang BC, Shi ZY, Wang B, Wu P, Kong LC, Yao JL, Li CW, Shi XL (2017) Intravenous zoledronic acid 5 mg on bone turnover markers and bone mineral density in east china subjects with newly diagnosed osteoporosis: a 24-month clinical study. Orthopaed Surg 9(1):103–109. https://doi.org/10.1111/os.12307CrossRef

31.

Jeon OC, Seo DH, Kim HS, Byun Y, Park JW (2016) Oral delivery of zoledronic acid by non-covalent conjugation with lysine-deoxycholic acid: in vitro characterization and in vivo anti-osteoporotic efficacy in ovariectomized rats. Eur J Pharm Sci 82:1–10. https://doi.org/10.1016/j.ejps.2015.11.004CrossRefPubMed

32.

Looker AC, Bauer DC, Chesnut CH 3rd, Gundberg CM, Hochberg MC, Klee G, Kleerekoper M, Watts NB, Bell NH (2000) Clinical use of biochemical markers of bone remodeling: current status and future directions. Osteoporos Int 11(6):467–480. https://doi.org/10.1007/s001980070088CrossRefPubMed

33.

Zhu SY, Zhong ZM, Wu Q, Chen JT (2016) Risk factors for bone cement leakage in percutaneous vertebroplasty: a retrospective study of four hundred and eighty five patients. Int Orthop 40(6):1205–1210. https://doi.org/10.1007/s00264-015-3102-2CrossRefPubMed

34.

Zhan Y, Jiang J, Liao H, Tan H, Yang K (2017) Risk factors for cement leakage after vertebroplasty or kyphoplasty: a meta-analysis of published evidence. World Neurosurg 101:633–642. https://doi.org/10.1016/j.wneu.2017.01.124CrossRefPubMed

35.

Rho YJ, Choe WJ, Chun YI (2012) Risk factors predicting the new symptomatic vertebral compression fractures after percutaneous vertebroplasty or kyphoplasty. Eur Spine J 21(5):905–911. https://doi.org/10.1007/s00586-011-2099-5CrossRefPubMed

Title: Effectiveness and safety of percutaneous kyphoplasty combined with zoledronic acid in treatment of osteoporotic vertebral compression fractures: a meta-analysis
Authors: Min Zhuang
Bin Cai
Fanfan Wang
Publication date: 13-03-2021
Publisher: Springer Berlin Heidelberg
Keyword: Zoledronic Acid
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 10/2022
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-021-03858-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effectiveness and safety of percutaneous kyphoplasty combined with zoledronic acid in treatment of osteoporotic vertebral compression fractures: a meta-analysis

Abstract

Introduction

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2022

Cycling-related orthopaedic fractures admitted to the Major Trauma Centre in the cycling capital of the UK

Efficacy of hook-type locking plate and partially threaded cancellous lag screw in the treatment of displaced medial malleolar fractures in elderly patients

High range of motion in the first ten postoperative days after TKA does not predict superior outcome in the long run

Treatment of acquired patella baja by proximalization tibial tubercle osteotomy significantly improved knee joint function but overall patient-reported outcome measures remain diminished after two to four years of follow-up

Clinical outcomes of anterior tibiofibular ligament’s distal fascicle transfer versus ligament reconstruction with InternalBrace™ for chronic ankle instability patients

Changes in joint space width over time and risk factors for deterioration of joint space width after medial opening-wedge high tibial osteotomy