Efficacy of zoledronic acid on postoperative osteoporosis vertebral fracture patients undergoing percutaneous vertebroplasty or percutaneous kyphoplasty: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YIN Xiaohong ¹ , DENG Junhao ² , WU Xie ³ , MENG Xiangyu ¹ , CAO Yue ¹ , CUI Cao ⁴ ,  ZENG Xiantao ¹

1. Department of Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, P.R.China;
2. Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, P.R.China;
3. Department of Anesthesiology, FuWai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, P.R.China;
4. Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, 441021, P.R.China;

Corresponding author：

ZENG Xiantao, Email: zengxiantao1128@163.com

Keywords：

Percutaneous vertebroplasty; Percutaneous kyphoplasty; Zoledronic acid; Osteoporosis vertebral fracture; Randomized controlled trial; Meta-analysis; Back pain; Bone density; Systematic review

DOI：

10.7507/1672-2531.201607054

Video：

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ObjectiveTo systematically review the efficacy of zoledronic acid (ZOL) on postoperative osteoporosis vertebral fracture (OVFs) of patients undergoing percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP).MethodsWe searched databases including PubMed, EMbase, CBM, CNKI, VIP and WanFang Data to collect randomized controlled trials (RCTs) about ZOL on postoperative OVFs of patients undergoing PVP or PKP from inception to June 30^th, 2016. Two reviewers independently screened literature, extracted data and assessed the risk bias of included studies. Then, RevMan 5.3 software was used for meta-analysis.ResultsA total of 11 RCTs involving 950 cases of OVFs were included. The results of meta-analysis showed that: the bone mineral densities of the ZOL group at 6 months (SMD=0.62, 95%CI 0.06 to 1.18, P=0.03) and 12 months (SMD=1.32, 95%CI 0.62 to 2.02, P=0.000 2) after the operation were higher than those of the control group. The re-fracture risk of the ZOL group was lower than that of the control group (RR=0.27, 95%CI 0.16 to 0.47, P<0.000 01). The visual analogue scales of the ZOL group were lower than those of the control group at 3 weeks (SMD=–1.03, 95%CI –1.42 to –0.63, P<0.000 01), 1 month (SMD=–1.57, 95%CI –2.30 to –0.83, P<0.000 01), 3 months (SMD=–1.53, 95%CI –2.20 to –0.86, P<0.000 01), 6 months (SMD=–2.59, 95%CI –3.42 to –1.76, P<0.000 01), and 12 months (SMD=–2.69, 95%CI –4.21 to –1.18, P=0.000 5) after the operation. In addition, Oswestry disability index (ODI) score of the ZOL group was better than that of the control group at 1 year after the operation (SMD=–1.61, 95% CI–2.42 to –0.81, P<0.000 1).ConclusionsThe current evidence shows that the usage of ZOL after PVP/PKP has better effects, it relieves the pain further, increases the quantity of bone significantly, ameliorates the BMD, reduces the incidence of re-fracture and improves the quality of life. Due to the limited quantity and quality of included studies, more high-quality studies are needed to verify the above conclusion.

Citation： YIN Xiaohong, DENG Junhao, WU Xie, MENG Xiangyu, CAO Yue, CUI Cao, ZENG Xiantao. Efficacy of zoledronic acid on postoperative osteoporosis vertebral fracture patients undergoing percutaneous vertebroplasty or percutaneous kyphoplasty: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2017, 17(8): 964-972. doi: 10.7507/1672-2531.201607054 Copy

1.	Nikolaou VS, Efstathopoulos N, Kontakis G, et al. The influence of osteoporosis in femoral fracture healing time. Injury, 2009, 40(6): 663-668.
2.	Tárker M, Aslan A, Cirpar M, et al. Histological and biomechanical effects of zoledronate on fracture healing in an osteoporotic rat tibia model. Eklem Hastalik Cerrahisi, 2016, 27(1): 9-15.
3.	Hernlund E, Svedbom A, Ivergard M, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos, 2013, 8(1-2): 136.
4.	Lin X, Xiong D, Peng YQ, et al. Epidemiology and management of osteoporosis in the People’s Republic of China: current perspectives. Clin Interv Aging, 2015, 10: 1017-1033.
5.	Tseng YY, Yang TC, Tu PH, et al. Repeated and multiple new vertebral compression fractures after percutaneuus transpedicular vertebmplasty. Spine, 2009, 34(18): 1917-1922.
6.	Chang X, Lv YF, Chen B, et al. Vertebroplasty versus kyphoplasty in osteoporotic vertebral compression fracture: a meta-analysis of prospective comparative studies. Orthop, 2015, 39(3): 491-500.
7.	Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos, 2015, 26(7): 2045-2047.
8.	邱贵兴, 裴福兴, 胡祯明, 等. 中国骨质疏松性骨折诊疗指南. 中华骨与关节外科杂志, 2015, 8(5): 371-374.
9.	Nourinia R, Ahmadieh H, Rezaei-Kanavi M, et al. Safety of intravitreal zoledronic acid, an anti-angiogenic bisphosphonate, in a rat model. J Ophthalmic Vis Res, 2014, 9(1): 44-49.
10.	Hao Y, Wang X, Wang L, et al. Zoledronic acid suppresses callus remodeling but enhances callus strength in an osteoporotic rat model of fracture healing. Bone, 2015, 12(81): 702-711.
11.	Reid IR, Black DM, Eastell R, et al. Reduction in the risk of clinical fractures after a single dose of zoledronic Acid 5 milligrams. J Clin Endocrinol Metab, 2013, 98(2): 557-563.
12.	刘明明, 程建, 黄桂成, 等. 唑来膦酸与 PKP 治疗骨质疏松性椎体压缩骨折. 中国矫形外科杂志, 2015, 23(22): 2017-2020.
13.	张涛. 唑来膦酸辅助经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折疗效评价. 白求恩医学杂志, 2015, 13(5): 467-469.
14.	张亮, 王静成, 冯新民, 等. 唑来膦酸在骨质疏松性椎体压缩骨折椎体后凸成形术后的应用. 实用医学杂志, 2015, 31(2): 283-285.
15.	伍鹏欢. 骨水泥椎体成形术联合唑来膦酸治疗骨质疏松性椎体压缩骨折. 石家庄: 河北医科大学, 2015.
16.	严坚强, 孙奎, 梁必如, 等. 唑来膦酸在骨质疏松性椎体压缩骨折经皮椎体成形术后的临床应用. 中国骨质疏松杂志, 2014, 20(12): 1428-1431.
17.	张伟涛, 尚国伟, 刘宏建, 等. 综合治疗骨质疏松性椎体压缩性骨折的临床研究. 中华实验外科杂志, 2013, 30(3): 633-635.
18.	叶湛, 王敏, 郑锋, 等. 唑来膦酸治疗骨质疏松性骨折术后残余疼痛 29 例. 中国药业, 2013, 22(11): 102-103.
19.	李莹, 宁永明, 张春霖, 等. 唑来膦酸治疗椎体成形术后残余疼痛早期疗效观察. 中华创伤杂志, 2011, 27(5): 461-462.
20.	应洁静, 朱晓影, 金掌, 等. 注射唑来膦酸结合经皮骨水泥椎体成形治疗 OVCF 的疗效. 浙江临床医学, 2016, 18(4): 597-599.
21.	倪力刚, 史晓林. 唑来磷酸钠对椎体成形术后椎体再次骨折的影响. 杭州: 浙江省骨质疏松与骨矿盐疾病学术年会暨《骨质疏松症诊治进展》专题研讨班, 2012.
22.	朱晓波. 唑来膦酸联合经皮椎体后凸成形术对老年椎体压缩性骨折患者疗效及骨密度、骨代谢影响. 药物流行病学杂志, 2016, 25(5): 281-284.
23.	Black DM, Delmas PD, Eastell R, et al. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med, 2007, 356(18): 1809-1822.
24.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (Version 5.1.0). Available at: http://www. cochrane-handbook.org.
25.	Kunio Y, Masahiro K, Makoto Y, et al. Postoperative change in sagittal balance after Kyphoplasty for the treatment of osteoporotic vertebral compression fracture. Eur Spine, 2015, 24(4): 744-749.
26.	Berlemann U, Ferguson SJ. Adjacent vertebral failure after vertebroplasty. A biomechanical investigation. J Bone Joint Surg Br, 2002, 84(5): 748-752.
27.	Aquarius R, Homminga J, Verdonschot N, et al. The fracture risk of adjacent vertebrae is increased by the changed loading direction after a wedge fracture. Spine, 2011, 36(6): 408-412.
28.	Nancollas GH, Tang R, Phipps RJ, et al. Novel insights into actions of bisphosphonates on bone: differences in interactions with hydroxyapatite. Bone, 2006, 38(5): 617-627.
29.	Koivisto K, Kyllönen E, Haapea M, et al. Efficacy of zoledronic acid for chronic low back pain associated with Modic changes in magnetic resonance imaging. BMC Musculoskelet Disord, 2014, (15): 64.

1. Nikolaou VS, Efstathopoulos N, Kontakis G, et al. The influence of osteoporosis in femoral fracture healing time. Injury, 2009, 40(6): 663-668.
2. Tárker M, Aslan A, Cirpar M, et al. Histological and biomechanical effects of zoledronate on fracture healing in an osteoporotic rat tibia model. Eklem Hastalik Cerrahisi, 2016, 27(1): 9-15.
3. Hernlund E, Svedbom A, Ivergard M, et al. Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos, 2013, 8(1-2): 136.
4. Lin X, Xiong D, Peng YQ, et al. Epidemiology and management of osteoporosis in the People’s Republic of China: current perspectives. Clin Interv Aging, 2015, 10: 1017-1033.
5. Tseng YY, Yang TC, Tu PH, et al. Repeated and multiple new vertebral compression fractures after percutaneuus transpedicular vertebmplasty. Spine, 2009, 34(18): 1917-1922.
6. Chang X, Lv YF, Chen B, et al. Vertebroplasty versus kyphoplasty in osteoporotic vertebral compression fracture: a meta-analysis of prospective comparative studies. Orthop, 2015, 39(3): 491-500.
7. Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos, 2015, 26(7): 2045-2047.
8. 邱贵兴, 裴福兴, 胡祯明, 等. 中国骨质疏松性骨折诊疗指南. 中华骨与关节外科杂志, 2015, 8(5): 371-374.
9. Nourinia R, Ahmadieh H, Rezaei-Kanavi M, et al. Safety of intravitreal zoledronic acid, an anti-angiogenic bisphosphonate, in a rat model. J Ophthalmic Vis Res, 2014, 9(1): 44-49.
10. Hao Y, Wang X, Wang L, et al. Zoledronic acid suppresses callus remodeling but enhances callus strength in an osteoporotic rat model of fracture healing. Bone, 2015, 12(81): 702-711.
11. Reid IR, Black DM, Eastell R, et al. Reduction in the risk of clinical fractures after a single dose of zoledronic Acid 5 milligrams. J Clin Endocrinol Metab, 2013, 98(2): 557-563.
12. 刘明明, 程建, 黄桂成, 等. 唑来膦酸与 PKP 治疗骨质疏松性椎体压缩骨折. 中国矫形外科杂志, 2015, 23(22): 2017-2020.
13. 张涛. 唑来膦酸辅助经皮椎体后凸成形术治疗骨质疏松性椎体压缩骨折疗效评价. 白求恩医学杂志, 2015, 13(5): 467-469.
14. 张亮, 王静成, 冯新民, 等. 唑来膦酸在骨质疏松性椎体压缩骨折椎体后凸成形术后的应用. 实用医学杂志, 2015, 31(2): 283-285.
15. 伍鹏欢. 骨水泥椎体成形术联合唑来膦酸治疗骨质疏松性椎体压缩骨折. 石家庄: 河北医科大学, 2015.
16. 严坚强, 孙奎, 梁必如, 等. 唑来膦酸在骨质疏松性椎体压缩骨折经皮椎体成形术后的临床应用. 中国骨质疏松杂志, 2014, 20(12): 1428-1431.
17. 张伟涛, 尚国伟, 刘宏建, 等. 综合治疗骨质疏松性椎体压缩性骨折的临床研究. 中华实验外科杂志, 2013, 30(3): 633-635.
18. 叶湛, 王敏, 郑锋, 等. 唑来膦酸治疗骨质疏松性骨折术后残余疼痛 29 例. 中国药业, 2013, 22(11): 102-103.
19. 李莹, 宁永明, 张春霖, 等. 唑来膦酸治疗椎体成形术后残余疼痛早期疗效观察. 中华创伤杂志, 2011, 27(5): 461-462.
20. 应洁静, 朱晓影, 金掌, 等. 注射唑来膦酸结合经皮骨水泥椎体成形治疗 OVCF 的疗效. 浙江临床医学, 2016, 18(4): 597-599.
21. 倪力刚, 史晓林. 唑来磷酸钠对椎体成形术后椎体再次骨折的影响. 杭州: 浙江省骨质疏松与骨矿盐疾病学术年会暨《骨质疏松症诊治进展》专题研讨班, 2012.
22. 朱晓波. 唑来膦酸联合经皮椎体后凸成形术对老年椎体压缩性骨折患者疗效及骨密度、骨代谢影响. 药物流行病学杂志, 2016, 25(5): 281-284.
23. Black DM, Delmas PD, Eastell R, et al. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med, 2007, 356(18): 1809-1822.
24. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (Version 5.1.0). Available at: http://www. cochrane-handbook.org.
25. Kunio Y, Masahiro K, Makoto Y, et al. Postoperative change in sagittal balance after Kyphoplasty for the treatment of osteoporotic vertebral compression fracture. Eur Spine, 2015, 24(4): 744-749.
26. Berlemann U, Ferguson SJ. Adjacent vertebral failure after vertebroplasty. A biomechanical investigation. J Bone Joint Surg Br, 2002, 84(5): 748-752.
27. Aquarius R, Homminga J, Verdonschot N, et al. The fracture risk of adjacent vertebrae is increased by the changed loading direction after a wedge fracture. Spine, 2011, 36(6): 408-412.
28. Nancollas GH, Tang R, Phipps RJ, et al. Novel insights into actions of bisphosphonates on bone: differences in interactions with hydroxyapatite. Bone, 2006, 38(5): 617-627.
29. Koivisto K, Kyllönen E, Haapea M, et al. Efficacy of zoledronic acid for chronic low back pain associated with Modic changes in magnetic resonance imaging. BMC Musculoskelet Disord, 2014, (15): 64.

Chinese Journal of Evidence-Based Medicine

Efficacy of zoledronic acid on postoperative osteoporosis vertebral fracture patients undergoing percutaneous vertebroplasty or percutaneous kyphoplasty: a meta-analysis

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