加来信広，鳥巣岳彦，高下光弘： 大腿骨頸部骨折の治療，整形・災害外科1998；41：547-553.
日本整形外科学会／日本骨折治療学会監修：大腿骨頚部／転子部骨折診療ガイドライン【改訂第2版】、南江堂, 2011.
M J Parker, H H Handoll
Pre-operative traction for fractures of the proximal femur.
Cochrane Database Syst Rev. 2001;(3):CD000168. doi: 10.1002/14651858.CD000168.
Abstract/Text
BACKGROUND: Pre-operative traction following an acute hip fracture remains standard practice in some hospitals.
OBJECTIVES: To evaluate the effects of traction applied to the injured limb prior to surgery for a fractured hip. Different methods of applying traction (skin or skeletal) were considered.
SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group's specialised register (April 2001), the Cochrane Controlled Trials Register (The Cochrane Library Issue 1, 2001), MEDLINE (1966 to February 2001), EMBASE (1988 to 2001 Week 11), CINAHL (1982 to February 2001), the National Research Register Issues 3, 2000 and 1, 2001, and reference lists of articles. Date of most recent search: April 2001.
SELECTION CRITERIA: All randomised or quasi-randomised trials comparing either skin or skeletal traction with no traction, or skin with skeletal traction for patients with an acute hip fracture prior to surgery.
DATA COLLECTION AND ANALYSIS: Both reviewers independently assessed trial quality, using a nine item scale, and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, the data are presented graphically.
MAIN RESULTS: Seven randomised trials, mainly of moderate quality, involving a total of 1038 predominantly elderly patients, were identified and included in the review. This review update includes a newly identified trial. The inclusion of this trial, which focussed on analgesia outcomes, resulted in no important change in the results or conclusions. Six trials compared traction with no traction. Although no data pooling was possible, overall these provided no evidence of benefit from traction, either in the relief of pain, ease of fracture reduction or quality of fracture reduction at time of surgery. One of these trials included both skin and skeletal traction groups. This trial and one other which compared skeletal traction with skin traction found no important differences between these two methods, although the initial application of skeletal traction was noted as being more painful and most costly.
REVIEWER'S CONCLUSIONS: From the evidence available, the routine use of traction (either skin or skeletal) prior to surgery for a hip fracture does not appear to have any benefit. However, the evidence is also insufficient to rule out the potential advantages for traction, in particular for specific fracture types, or to confirm additional complications due to traction use. Further, high quality trials would be required to confirm or refute the absence of benefits of traction.
Arun Kannan, Ramprasad Kancherla, Stephen McMahon, Gabrielle Hawdon, Aditya Soral, Rajesh Malhotra
Arthroplasty options in femoral-neck fracture: answers from the national registries.
Int Orthop. 2012 Jan;36(1):1-8. doi: 10.1007/s00264-011-1354-z. Epub 2011 Sep 20.
Abstract/Text
PURPOSE: Femoral-neck fracture in the elderly population is a problem that demands the attention of the orthopaedic community as life expectancy continues to increase. There are several different treatment options in use, and this variety in and of itself indicates the absence of an ideal single treatment option. Recent debate has focussed on the probable superiority of total hip arthroplasty (THA) over hemiarthroplasty for femoral-neck fracture. Clinical trials and systematic reviews of such trials have not provided a convincing answer to this question.
METHODS: We analysed data from national registries evaluating prosthetic replacements for femoral-neck fracture in the elderly. We compared revision and reoperation rates of hemiarthroplasty and THA, analysed the prognostic variables that influenced implant survival and the major causes of failure.
RESULTS: Data from the Australian and Italian registries indicate that THA has an increased revision rate compared with bipolar hemiarthroplasty in femoral-neck fracture in the elderly. The registries identify that age over 75 years and the use of the anterior surgical approach are associated with better survivorship in patients who have a hemiarthroplasty. Cemented fixation of the femoral stem in hemiarthroplasty and THA is supported by registry data. Acetabular erosion accounted for a very low percentage of hemiarthroplasty revisions and reoperations.
CONCLUSION: Our review of data from national registries supports the continued use of bipolar hemiarthroplasty in femoral-neck fracture in the elderly and identifies age, method of fixation and surgical approach as important prognostic variables in determining implant survival.
Bjarke Viberg, Søren Overgaard, Jens Lauritsen, Ole Ovesen
Lower reoperation rate for cemented hemiarthroplasty than for uncemented hemiarthroplasty and internal fixation following femoral neck fracture: 12- to 19-year follow-up of patients aged 75 years or more.
Acta Orthop. 2013 Jun;84(3):254-9. doi: 10.3109/17453674.2013.792033. Epub 2013 Apr 18.
Abstract/Text
BACKGROUND AND PURPOSE: Elderly patients with displaced femoral neck fractures are commonly treated with a hemiarthroplasty (HA), but little is known about the long-term failure of this treatment. We compared reoperation rates for patients aged at least 75 years with displaced femoral neck fractures treated with either internal fixation (IF), cemented HA, or uncemented HA (with or without hydroxyapatite coating), after 12-19 years of follow-up.
METHODS: 4 hospitals with clearly defined guidelines for the treatment of 75+ year-old patients with a displaced femoral neck fracture were included. Cohort 1 (1991-1993) with 180 patients had undergone IF; cohort 2 (1991-1995) with 203 patients had received an uncemented bipolar Ultima HA stem (Austin-Moore); cohort 3 (1991-1995) with 209 patients had received a cemented Charnley-Hastings HA; and cohort 4 (1991-1998) with 158 patients had received an uncemented hydroxyapatite-coated Furlong HA. Data were retrieved from patient files, from the region-based patient administrative system, and from the National Registry of Patients at the end of 2010. We performed survival analysis with adjustment for comorbidity, age, and sex.
RESULTS: Cemented HA had a reoperation rate (RR) of 5% and was used as reference in the Cox regression analysis, which showed significantly higher hazard ratios (HRs) for IF (HR = 3.8, 95% CI: 1.9-7.5; RR = 18%), uncemented HA (HR = 2.2, CI: 1.1-4.5; RR = 11%) and uncemented hydroxyapatite-coated HA (HR = 3.6, CI: 1.8-7.4; RR = 16%).
INTERPRETATION: Cemented HA has a superior long-term hip survival rate compared to IF and uncemented HA (with and without hydroxyapatite coating) in patients aged 75 years or more with displaced femoral neck fractures.
Chen-Chiang Lin, Shier-Chieg Huang, Yang-Kun Ou, Yung-Ching Liu, Ching-Mei Tsai, Hsin-Hui Chan, Chen-Ti Wang
Survival of patients aged over 80 years after Austin-Moore hemiarthroplasty and bipolar hemiarthroplasty for femoral neck fractures.
Asian J Surg. 2012 Apr;35(2):62-6. doi: 10.1016/j.asjsur.2012.04.002. Epub 2012 Jun 2.
Abstract/Text
OBJECTIVES: Hemiarthroplasty is recommended for treatment of displaced femoral neck fractures in physically compromised elderly patients. The objective of this study was to analyze survival of patients aged >80 years after the implantation of either an Austin-Moore type prosthesis or a bipolar bearing prosthesis.
METHODS: An Austin-Moore or bipolar hemiarthroplasty was implanted into 120 patients aged >80 years. Demographic data were collected. Survival rate at 5 years and factors related to mortality were analyzed.
RESULTS: Sixty-two patients received Austin-Moore hemiarthroplasty, and 58 received bipolar hemiarthroplasty. No significant differences in gender, comorbid conditions, ASA scores, duration of hospitalization, intraoperative blood loss, duration from injury to operation, or postoperative morbidity between the two groups were found. However, patients who received the Austin-Moore hemiarthroplasty were older and had shorter operation time than those who received bipolar hemiarthroplasty. Kaplan-Meier estimates of 5 years survival were 40.0% for patients who received Austin-Moore hemiarthroplasty, and 62.9% for patients who received bipolar hemiarthroplasty. Cox proportional hazard regression analysis of risks factors of death revealed that patients who underwent Austin-Moore hemiarthroplasty were 2.0-fold more likely to die when compared to those who received bipolar hemiarthroplasty.
CONCLUSIONS: Elderly patients who receive bipolar hemiarthroplasty may have a more favorable survival outcome when compared to those who receive unipolar hemiarthroplasty.
Copyright © 2012. Published by Elsevier B.V.
Kari Kanto, Raine Sihvonen, Antti Eskelinen, Minna Laitinen
Uni- and bipolar hemiarthroplasty with a modern cemented femoral component provides elderly patients with displaced femoral neck fractures with equal functional outcome and survivorship at medium-term follow-up.
Arch Orthop Trauma Surg. 2014 Sep;134(9):1251-9. doi: 10.1007/s00402-014-2053-1. Epub 2014 Jul 24.
Abstract/Text
INTRODUCTION: The choice between unipolar and bipolar hemiarthroplasty for treatment of displaced intracapsular femoral neck fractures in elderly patients still remains controversial. Our objective was to compare series of elderly individuals with a displaced femoral neck fracture treated with either a cemented, modular unipolar or bipolar prosthesis with the same femoral component.
MATERIALS AND METHODS: A prospective, randomized controlled trial of 175 displaced intracapsular femoral neck fractures in patients over 65 years was randomly allocated to unipolar (88) and to bipolar (87) hemiarthroplasty group. The primary end point was implant survival. Secondary end points included difference in ambulatory ability and mortality. Follow-up evaluations were performed at 2 months, at 1, 3 and 5 years. Implant and patient survival were followed until 2/2012. Survival analyses were performed using Kaplan-Meier curves with log-rank test. Data were analyzed using Chi-square test and Student's t test.
RESULTS: Unipolar hemiarthroplasty group had a significantly higher dislocation rate when compared with bipolar hemiarthroplasty group. This did not translate into difference in revision rates at 8 years. Prosthetic survival ship was 0.98 (95% Cl 0.94-1.00) in the unipolar group and 0.97 (95% Cl 0.93-1.00) in the bipolar group. There were no statistically significant differences in ambulatory ability, possibility to return home mortality or early radiological acetabular erosion. There were significantly more one-time dislocations in the unipolar group, but there was no difference in incidence of revisions due to recurrent dislocations. The overall mortality rate was 6% at 30 days, 9% at 90 days, 16% at 12 months, and 53% at 5 years. There was no difference in mortality between the groups.
CONCLUSIONS: Unipolar hemiarthroplasty group had a significantly higher dislocation rate when compared with bipolar hemiarthroplasty group. However, both provide elderly patients with equal ambulatory ability and low revision rate at medium-term follow-up.
J M Skelly, G H Guyatt, R Kalbfleisch, J Singer, L Winter
Management of urinary retention after surgical repair of hip fracture.
CMAJ. 1992 Apr 1;146(7):1185-9.
Abstract/Text
OBJECTIVE: To compare the use of indwelling catheters and intermittent catheterization in the management of urinary retention after surgical repair of hip fractures.
DESIGN: Randomized open trial.
SETTING: Orthopedic unit in a general hospital.
PATIENTS: Patients 60 years or more admitted to hospital for surgical repair of a hip fracture between November 1986 and December 1987. Of the 76 who were eligible and agreed to participate 5 became medically unstable, 2 died before surgery, and 2 did not have urinary retention after surgery. The remaining 55 women and 12 men were randomly assigned to one of two treatment groups.
INTERVENTION: An indwelling catheter inserted preoperatively was removed 48 hours after surgery (group 1); the procedure was repeated if necessary after 24 hours. Intermittent catheterization was performed every 6 to 8 hours (group 2); the frequency was adjusted to avoid bladder distension.
MAIN OUTCOME MEASURE: Pattern of return to satisfactory voiding within 5 postoperative days.
RESULTS: Of the patients in group 1, 37% resumed voiding within the 5-day postoperative period, as compared with 66% in group 2 (p less than 0.025). The mean numbers of days for return to satisfactory voiding were 9.4 and 5.1 respectively (difference 4.3 days, p less than 0.01, 95% confidence interval 0.7 to 8.0 days). Urinary tract infections developed in 31% of those in group 1 and 38% of those in group 2; the difference was not significant.
CONCLUSION: Satisfactory voiding resumes earlier with the use of intermittent catheterization, if begun at the onset of urinary retention and repeated at regular intervals, than with the use of an indwelling catheter in elderly patients who have undergone surgical repair of hip fractures.
Benjamin Buecking, Nina Timmesfeld, Sarwiga Riem, Christopher Bliemel, Erich Hartwig, Thomas Friess, Ulrich Liener, Steffen Ruchholtz, Daphne Eschbach
Early orthogeriatric treatment of trauma in the elderly: a systematic review and metaanalysis.
Dtsch Arztebl Int. 2013 Apr;110(15):255-62. doi: 10.3238/arztebl.2013.0255. Epub 2013 Apr 12.
Abstract/Text
BACKGROUND: More than 125,000 hip fractures occur in Germany every year, with a one-year mortality of about 25%. To improve treatment outcomes, models of cooperation between trauma surgery and geriatrics have been developed. Their benefit has not yet been unequivocally demonstrated.
METHODS: We systematically searched the Medline database and the Cochrane Library for prospective randomized controlled trials in which the treatment of elderly patients with fractures by the trauma surgery service alone was compared with preoperatively initiated collaborative treatment by the trauma surgery and geriatric services ("orthogeriatric" treatment). We investigated three treatment outcome variables--length of hospital stay, in-hospital mortality, and one-year mortality--in a metaanalysis.
RESULTS: The five trials of hip fracture treatment that met the selection criteria all had relatively small study populations and a high risk of bias. The outcomes with respect to hospital stay differed greatly among trials (I(2): 88.5%), and geriatric intervention was not found to have any statistically significant effect (0.06 days, 95% confidence interval [CI]: -3.74 to 3.62 days). The relative risk of dying in the hospital was 0.66 for orthogeriatric treatment (95% CI: 0.28-1.55, p = 0.34), and the hazard ratio for one-year mortality was 0.79 in favor of orthogeriatric treatment (95% CI: 0.57 to 1.10, p = 0.17). A metaanalysis of functional outcomes was not possible.
CONCLUSION: Only a few randomized controlled trials of early orthogeriatric treatment have been performed, and these trials are of limited quality. Due to low case numbers, a benefit from interdisciplinary orthogeriatric treatment could not clearly be demonstrated. Further trials are needed.
Klaus Hauer, Norbert Specht, Matthias Schuler, Peter Bärtsch, Peter Oster
Intensive physical training in geriatric patients after severe falls and hip surgery.
Age Ageing. 2002 Jan;31(1):49-57. doi: 10.1093/ageing/31.1.49.
Abstract/Text
BACKGROUND: Intensive exercise training can lead to improvement in strength and functional performance in older people living at home and nursing home residents. There is little information whether intensive physical exercise may be applicable and effective in elderly patients suffering from the acute sequelae of injurious falls or hip surgery.
OBJECTIVE: To assess the feasibility, safety and efficacy of intensive, progressive physical training in rehabilitation after hip surgery.
DESIGN: Prospective, randomised, placebo-controlled intervention study of a 3-months training intervention and a 3-months' follow-up.
SETTING: Physical training 6-8 weeks after hip surgery.
SUBJECTS: Twenty-eight (15 intervention, 13 control) elderly patients with a history of injurious falls admitted to acute care or inpatient rehabilitation because of acute fall-related hip fracture or elective hip replacement.
METHODS: Progressive resistance and functional training to improve strength and functional performance.
RESULTS: No training-related medical problems occurred in the study group. Twenty-four patients (86%) completed all assessments during the intervention and follow-up period. Adherence was excellent in both groups (intervention: 93, 0+/-13, 5% versus control: 96, 7+/-6, 2%). Training significantly increased strength, functional motor performance and balance and reduced fall-related behavioural and emotional problems. Some improvements in strength persisted during 3-months follow-up while other strength variables and functional performances were lost after cessation of training. Patients in the control group showed no change in strength, functional performance and emotional state during intervention and follow-up.
CONCLUSIONS: Progressive resistance training and progressive functional training are safe and effective methods to increase strength and functional performance during rehabilitation in patients after hip surgery and a history of injurious falls. Because part of the training improvements were lost after stopping the training, a continuing training regime should be established.
Ellen F Binder, Marybeth Brown, David R Sinacore, Karen Steger-May, Kevin E Yarasheski, Kenneth B Schechtman
Effects of extended outpatient rehabilitation after hip fracture: a randomized controlled trial.
JAMA. 2004 Aug 18;292(7):837-46. doi: 10.1001/jama.292.7.837.
Abstract/Text
CONTEXT: Hip fractures are common in the elderly, and despite standard rehabilitation, many patients fail to regain their prefracture ambulatory or functional status.
OBJECTIVE: To determine whether extended outpatient rehabilitation that includes progressive resistance training improves physical function and reduces disability compared with low-intensity home exercise among physically frail elderly patients with hip fracture.
DESIGN, SETTING, AND PATIENTS: Randomized controlled trial conducted between August 1998 and May 2003 among 90 community-dwelling women and men aged 65 years or older who had had surgical repair of a proximal femur fracture no more than 16 weeks prior and had completed standard physical therapy.
INTERVENTION: Participants were randomly assigned to 6 months of either supervised physical therapy and exercise training (n = 46) or home exercise (control condition; n = 44).
MAIN OUTCOME MEASURES: Primary outcome measures were total scores on a modified Physical Performance Test (PPT), the Functional Status Questionnaire physical function subscale (FSQ), and activities of daily living scales. Secondary outcome measures were standardized measures of skeletal muscle strength, gait, balance, quality of life, and body composition. Participants were evaluated at baseline, 3 months, and 6 months.
RESULTS: Changes over time in the PPT and FSQ scores favored the physical therapy group (P =.003 and P =.01, respectively). Mean change (SD) in PPT score for physical therapy was +6.5 (5.5) points (95% confidence interval [CI], 4.6-8.3), and for the control condition was +2.5 (3.7) points (95% CI, 1.4-3.6 points). Mean change (SD) in FSQ score for physical therapy was +5.2 (5.4) points (95% CI, 3.5-6.9) and for the control condition was +2.9 (3.8) points (95% CI, 1.7-4.0). Physical therapy also had significantly greater improvements than the control condition in measures of muscle strength, walking speed, balance, and perceived health but not bone mineral density or fat-free mass.
CONCLUSION: In community-dwelling frail elderly patients with hip fracture, 6 months of extended outpatient rehabilitation that includes progressive resistance training can improve physical function and quality of life and reduce disability compared with low-intensity home exercise.
Magnus Eneroth, Ulla-Britt Olsson, Karl-Göran Thorngren
Nutritional supplementation decreases hip fracture-related complications.
Clin Orthop Relat Res. 2006 Oct;451:212-7. doi: 10.1097/01.blo.0000224054.86625.06.
Abstract/Text
Protein energy malnutrition is an important determinant of clinical outcome in older patients after hip fracture, but the effectiveness of nutritional support programs in routine clinical practice is controversial. We performed a prospective, randomized, controlled clinical trial to determine if nutritional supplementation decreased fracture-related complications in a selection of otherwise healthy patients with hip fractures. Patients were randomized to intervention or control groups. The control group (n = 40) was given ordinary hospital food and beverage. The intervention group (n = 40) also was administered a 1000 kcal daily intravenous supplement for 3 days, followed by a 400 kcal oral nutritional supplement for 7 days. We recorded daily fluid and energy intake during the first 10 days of hospitalization and fracture-related complications up to 4 months. The total fluid and energy intake in the intervention group neared optimal levels. The control group received 54% and 64% of optimal energy and fluid intake, respectively. The risk of fracture- related complications was greater in the control group (70%) than in the intervention group (15%). Four patients in the control group died within 120 days postoperatively. The comprehensive balanced nutrition supplement resulted in lower complication rates and mortality at 120 days postoperatively.
D S Damany, Martyn J Parker, Adrian Chojnowski
Complications after intracapsular hip fractures in young adults. A meta-analysis of 18 published studies involving 564 fractures.
Injury. 2005 Jan;36(1):131-41. doi: 10.1016/j.injury.2004.05.023.
Abstract/Text
UNLABELLED: Intracapsular hip fractures in young adults have a significant risk of complications. Consequently, some authors advocate urgent and/or open fracture reduction. Our aim was to analyse outcomes following such fractures with reference to influence of fracture displacement, timing of surgery and method of reduction (open/closed) on the incidence of non-union (NU) and avascular necrosis (AVN).
METHODS: Specific search terms were used to retrieve relevant published studies from 1966 to May 2003.
RESULTS: Eighteen studies involving 564 fractures were analysed. The overall incidence of NU was 50/564 (8.9%) and AVN was 130/564 (23.0%). There was a higher incidence of NU and AVN following displaced than undisplaced fractures. NU occurred more frequently after open reduction than closed reduction (10/89 [11.2%] versus 13/275 [4.7%]). There was an increased incidence of AVN after closed than open reduction but this was no longer statistically significant when one study with a markedly higher reported incidence of AVN was excluded. The difference in the incidence of NU and AVN following early (<12h) or late (>12 h) surgery was not significant for either NU or AVN.
CONCLUSION: Early or open reduction of these fractures may not reduce the risk of NU or AVN. There is a suggestion of a higher incidence of NU following open reduction than closed reduction. Randomised studies with 2 year follow-up are required to report on a larger number of patients before definite conclusions on treatment can be made.
Kevin S Conn, Martyn J Parker
Undisplaced intracapsular hip fractures: results of internal fixation in 375 patients.
Clin Orthop Relat Res. 2004 Apr;(421):249-54.
Abstract/Text
Three hundred seventy-five patients with an undisplaced intracapsular proximal femoral fracture were treated with internal fixation. Nonunion occurred in 24 patients (6.4%) and avascular necrosis occurred in 15 patients (4.0%). Reoperation with an arthroplasty was required in 29 patients (7.7%). The age, walking ability of the patient, and degree of impaction seen on the anteroposterior radiograph or angulation seen on the lateral radiographs were of statistical significance in predicting fracture healing complications. The results for this series of patients were compared with the results in published reports identified by a comprehensive literature search. Summation of the results indicated that the overall risk of redisplacement or nonunion of the fracture was 4.3% (95% confidence interval, 3.4%-5.3%) with internal fixation of an undisplaced intracapsular fracture. For conservative treatment, the failure rate was 19.6% (95% confidence interval, 17.2%-22.1%). The incidence of avascular necrosis with internal fixation at 1 year was 2.2% (95% confidence interval, 1.6%-2.9%) compared with 2.8% (95% confidence interval, 1.9%-4.0%) with nonoperative treatment. Internal fixation is recommended for the treatment of undisplaced intracapsular hip fractures.
M Clare Robertson, A John Campbell, Melinda M Gardner, Nancy Devlin
Preventing injuries in older people by preventing falls: a meta-analysis of individual-level data.
J Am Geriatr Soc. 2002 May;50(5):905-11. doi: 10.1046/j.1532-5415.2002.50218.x.
Abstract/Text
OBJECTIVES: Our falls prevention research group has conducted four controlled trials of a home exercise program to prevent falls in older people. The objectives of this meta-analysis of these trials were to estimate the overall effect of the exercise program on the numbers of falls and fall-related injuries and to identify subgroups that would benefit most from the program.
DESIGN: We pooled individual-level data from the four trials to investigate the effect of the program in those aged 80 and older, in those with a previous fall, and in men and women.
SETTING: Nine cities and towns in New Zealand.
PARTICIPANTS: One thousand sixteen community dwelling women and men aged 65 to 97.
INTERVENTION: A program of muscle strengthening and balance retraining exercises designed specifically to prevent falls and individually prescribed and delivered at home by trained health professionals.
MEASUREMENTS: Main outcomes were number of falls and number of injuries resulting from falls during the trials.
RESULTS: The overall effect of the program was to reduce the number of falls and the number of fall-related injuries by 35% (incidence rate ratio (IRR) = 0.65, 95% confidence interval (CI) = 0.57-0.75; and, respectively IRR = 0.65, 95% CI = 0.53-0.81.) In injury prevention, participants aged 80 and older benefited significantly more from the program than those aged 65 to 79. The program was equally effective in reducing fall rates in those with and without a previous fall, but participants reporting a fall in the previous year had a higher fall rate (IRR = 2.34, 95% CI = 1.64-3.34). The program was equally effective in men and women.
CONCLUSION: This exercise program was most effective in reducing fall-related injuries in those aged 80 and older and resulted in a higher absolute reduction in injurious falls when offered to those with a history of a previous fall.
Socrates E Papapoulos, Sara A Quandt, Uri A Liberman, Marc C Hochberg, Desmond E Thompson
Meta-analysis of the efficacy of alendronate for the prevention of hip fractures in postmenopausal women.
Osteoporos Int. 2005 May;16(5):468-74. doi: 10.1007/s00198-004-1725-z. Epub 2004 Sep 21.
Abstract/Text
Treatment with alendronate, a potent and specific inhibitor of bone resorption, is known to significantly reduce fracture risk among women with postmenopausal osteoporosis. The purpose of this meta-analysis was to assess the consistency of the effect of alendronate in reducing the risk of hip fracture among different studies and populations. Data from completed, randomized, treatment studies were pooled in a meta-analysis. The duration of the studies ranged from 1-4.5 years. The dose of alendronate ranged from 5-20 mg/day, with over 95% of patients receiving either 5 or 10 mg/day during the trials. In patients with a T-score of less than or equal to -2.0, or with a vertebral fracture, the effect on hip fracture risk consistently favored patients receiving alendronate therapy, with an overall reduction in risk of hip fracture of 45% [95% confidence interval (CI) 16% to 64%, P=0.007]. For patients who met the criteria of osteoporosis, as defined by the World Health Organization (WHO), the overall risk reduction was 55% (95% CI 29% to 72%, P=0.0008). In both analyses we performed a sensitivity analysis by removing one study at a time. The strength of the evidence was not dependent on any one study. We conclude that therapy with alendronate is associated with significant and clinically important reductions in the incidence of hip fracture in women with postmenopausal osteoporosis. The overall reduction is consistent among different patient populations.
Deting Xue, Fangcai Li, Gang Chen, Shigui Yan, Zhijun Pan
Do bisphosphonates affect bone healing? A meta-analysis of randomized controlled trials.
J Orthop Surg Res. 2014 Jun 5;9:45. doi: 10.1186/1749-799X-9-45. Epub 2014 Jun 5.
Abstract/Text
BACKGROUND: Whether bisphosphonates affect indirect bone healing is still unclear.
METHOD: We carried out a comprehensive search strategy. Only randomized controlled trials were included. Two reviewers independently assessed methodological qualities and extracted outcome data. Analysis was performed with RevMan 5.2.
RESULTS: Eight eligible randomized controlled trials with 2,508 patients were included. Meta-analysis results showed that no statistically significant differences were founded in indirect bone healing in short time (within 3 months) (relative risk (RR) 1.40, relative the control group; 95% CI 0.36 to 5.49) and in long-term (more than 12 months) postoperation (RR 1.0; 95% CI 0.98 to 1.02) between bisphosphonates infusion groups and control groups. There were no statistically significant differences of indirect bone healing between early and delay bisphosphonates administration groups. Bisphosphonates infusion after lumbar infusion surgery could promote bone healing and shorten fusion time in 6 months postoperation (RR 1.35; 95% CI 1.11 to 1.66).
CONCLUSION: There was no clinically detectable delay to fracture healing via external callus formation following bisphosphonates treatment. Considering the benefit aspects of bisphosphonates for osteoporosis treatment, we recommend bisphosphonates infusion after fracture fixation surgery and lumbar fusion surgery.
久保俊一編：股関節外科の要点と盲点（整形外科Knack&Pitfalls）．文光堂，2005．.
