- Letter to the Editor
- Open Access
- Published:
Letter to the Editor: Oral risedronate increases Gruen zone bone mineral density after primary total hip arthroplasty: a meta-analysis
Journal of Orthopaedic Surgery and Research volume 17, Article number: 8 (2022)
Dear editors,
Recently, we read a meta-analysis by Li et al. [1] entitled “Oral risedronate increases Gruen zone bone mineral density after primary total hip arthroplasty: a meta-analysis” with great interest. Periprosthetic bone loss after total hip arthroplasty is an inevitable phenomenon mainly due to stress shielding, which may predispose to aseptic loosening, periprosthetic fractures and challenges at revision surgery. We appreciate the authors’ work in this field, however, some issues in the article that may nullify the conclusion need to be mentioned.
Firstly, the authors declared that they had systematically retrieved electronic databases including PubMed, Embase, Web of Science, Cochrane Library, and Chinese Wanfang database. However, to our knowledge, a study by Yin et al. [2] in Wanfang database was eligible on the basis of inclusion criteria, which could be involved in this meta-analysis and beneficial to draw a more comprehensive and convincing conclusion.
Secondly, we noticed that four of the included studies with short-term follow-up (6–12 months) revealed significant efficacy of risedronate while the left one with relatively longer follow-up (4 years) drew the exact opposite conclusion. Although these studies showed excellent homogeneousness, it was improper to ignore the potential reasons for such difference and simply put them into pooled analysis, which without any doubt would bring extra bias and lead to an incorrect conclusion.
Thirdly, it is obvious that two of the included studies (Skoldenberg, 2011 and Kumar, 2011) were the same article. What’s more, both of them and Muren et al. [3] came from the same clinical cohort. Thus, extracting duplicate data from these three articles for analysis would be more likely to lead to an incorrect conclusion and misleading clinical practice. Given that four of the eligible RCTs were followed up no more than 1 year except Muren et al. (4-year follow-up), we recommend to rule out Muren et al. and conduct a short-term (≤ 1 year) meta-analysis in a reference of the work by Shi et al. [4]. Details of these eligible studies are shown in Table 1.
Fourthly, we find that there are another four similar meta-analyses published online in 2018 [5,6,7,8]. All of them were performed following the guideline of PRISMA and four declared that they were the first meta-analysis on this topic, while none of them had a protocol registration in any platform, such as the Cochrane Library and PROSPERO. The meta-analysis registration is very essential to not only improve the quality of reporting, but also provide transparency and avoid repetitive publications.
Finally, it is not rigorous and persuasive enough for authors to conclude that risedronate could significantly reduce periprosthetic bone loss around an uncemented femoral stem, for the long-standing drug efficacy on periprosthetic bone loss and the benefit of final prognosis are still inconclusive. Larger clinical trials that focus on clinically relevant endpoints with a longer duration of follow-up are warranted.
Availability of data and materials
Not applicable.
Abbreviations
- RCT:
-
Randomized Controlled Trial
- PRISMA:
-
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
References
Li Q, Xu B. Oral risedronate increases Gruen zone bone mineral density after primary total hip arthroplasty: a meta-analysis. J Orthop Surg Res. 2018;13(1):144. https://doi.org/10.1186/s13018-018-0794-1.
Yin P, Yao Y, Cui LH, et al. Effect of risedronate on early postoperative periprosthetic bone mineral density of the proximal femur after cementless total hip arthroplasty. Chin J Osteoporosis. 2013;19:732–6 (Chinese).
Muren O, Akbarian E, Salemyr M, et al. No effect of risedronate on femoral periprosthetic bone loss following total hip arthroplasty. A 4-year follow-up of 61 patients in a double-blind, randomized placebo-controlled trial. Acta Orthop. 2015;86:569–74. https://doi.org/10.3109/17453674.2015.1041846.
Shi J, Liang G, Huang R, Liao L, Qin D. Effects of bisphosphonates in preventing periprosthetic bone loss following total hip arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res. 2018;13(1):225. https://doi.org/10.1186/s13018-018-0918-7.
Su J, Wei Y, Li XM, Diao YP, Liu HG, Zhang L. Efficacy of risedronate in improving bone mineral density in patients undergoing total hip arthroplasty: a meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018;97(51):e13346. https://doi.org/10.1097/MD.0000000000013346.
Ren L, Wang W. Effect of risedronate on femoral periprosthetic bone loss following total hip replacement: a systematic review and meta-analysis. Medicine (Baltimore). 2018;97(17):e0379. https://doi.org/10.1097/MD.0000000000010379.
Yang L. The efficiency of risedronate in reducing bone resorption after total hip arthroplasty: a meta-analysis of randomized control trials at a minimum of 6 months’ follow-up. J Orthop Surg Res. 2018;13(1):88. https://doi.org/10.1186/s13018-018-0808-z.
Wang M, Wang L, Ye R. Risedronate reduces postoperative bone resorption after cementless total hip arthroplasty: a systematic review and meta-analysis. Int J Surg. 2018;52:189–200. https://doi.org/10.1016/j.ijsu.2018.02.007.
Acknowledgements
Not applicable.
Funding
Not applicable.
Author information
Authors and Affiliations
Contributions
Kai Huang and Gang Wang conceived the study; Kai Huang wrote and edited the paper; Yi Zeng read and approved the final manuscript.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
The authors declare that they have no competing interests.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Huang, K., Wang, G. & Zeng, Y. Letter to the Editor: Oral risedronate increases Gruen zone bone mineral density after primary total hip arthroplasty: a meta-analysis. J Orthop Surg Res 17, 8 (2022). https://doi.org/10.1186/s13018-021-02891-8
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s13018-021-02891-8