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.	邱貴興, 裴福興, 胡禎明, 等. 中國骨質疏松性骨折診療指南. 中華骨與關節外科雜志, 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.	劉明明, 程建, 黃桂成, 等. 唑來膦酸與 PKP 治療骨質疏松性椎體壓縮骨折. 中國矯形外科雜志, 2015, 23(22): 2017-2020.
13.	張濤. 唑來膦酸輔助經皮椎體后凸成形術治療骨質疏松性椎體壓縮骨折療效評價. 白求恩醫學雜志, 2015, 13(5): 467-469.
14.	張亮, 王靜成, 馮新民, 等. 唑來膦酸在骨質疏松性椎體壓縮骨折椎體后凸成形術后的應用. 實用醫學雜志, 2015, 31(2): 283-285.
15.	伍鵬歡. 骨水泥椎體成形術聯合唑來膦酸治療骨質疏松性椎體壓縮骨折. 石家莊: 河北醫科大學, 2015.
16.	嚴堅強, 孫奎, 梁必如, 等. 唑來膦酸在骨質疏松性椎體壓縮骨折經皮椎體成形術后的臨床應用. 中國骨質疏松雜志, 2014, 20(12): 1428-1431.
17.	張偉濤, 尚國偉, 劉宏建, 等. 綜合治療骨質疏松性椎體壓縮性骨折的臨床研究. 中華實驗外科雜志, 2013, 30(3): 633-635.
18.	葉湛, 王敏, 鄭鋒, 等. 唑來膦酸治療骨質疏松性骨折術后殘余疼痛 29 例. 中國藥業, 2013, 22(11): 102-103.
19.	李瑩, 寧永明, 張春霖, 等. 唑來膦酸治療椎體成形術后殘余疼痛早期療效觀察. 中華創傷雜志, 2011, 27(5): 461-462.
20.	應潔靜, 朱曉影, 金掌, 等. 注射唑來膦酸結合經皮骨水泥椎體成形治療 OVCF 的療效. 浙江臨床醫學, 2016, 18(4): 597-599.
21.	倪力剛, 史曉林. 唑來磷酸鈉對椎體成形術后椎體再次骨折的影響. 杭州: 浙江省骨質疏松與骨礦鹽疾病學術年會暨《骨質疏松癥診治進展》專題研討班, 2012.
22.	朱曉波. 唑來膦酸聯合經皮椎體后凸成形術對老年椎體壓縮性骨折患者療效及骨密度、骨代謝影響. 藥物流行病學雜志, 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, Kyll?nen 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. 邱貴興, 裴福興, 胡禎明, 等. 中國骨質疏松性骨折診療指南. 中華骨與關節外科雜志, 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. 劉明明, 程建, 黃桂成, 等. 唑來膦酸與 PKP 治療骨質疏松性椎體壓縮骨折. 中國矯形外科雜志, 2015, 23(22): 2017-2020.
13. 張濤. 唑來膦酸輔助經皮椎體后凸成形術治療骨質疏松性椎體壓縮骨折療效評價. 白求恩醫學雜志, 2015, 13(5): 467-469.
14. 張亮, 王靜成, 馮新民, 等. 唑來膦酸在骨質疏松性椎體壓縮骨折椎體后凸成形術后的應用. 實用醫學雜志, 2015, 31(2): 283-285.
15. 伍鵬歡. 骨水泥椎體成形術聯合唑來膦酸治療骨質疏松性椎體壓縮骨折. 石家莊: 河北醫科大學, 2015.
16. 嚴堅強, 孫奎, 梁必如, 等. 唑來膦酸在骨質疏松性椎體壓縮骨折經皮椎體成形術后的臨床應用. 中國骨質疏松雜志, 2014, 20(12): 1428-1431.
17. 張偉濤, 尚國偉, 劉宏建, 等. 綜合治療骨質疏松性椎體壓縮性骨折的臨床研究. 中華實驗外科雜志, 2013, 30(3): 633-635.
18. 葉湛, 王敏, 鄭鋒, 等. 唑來膦酸治療骨質疏松性骨折術后殘余疼痛 29 例. 中國藥業, 2013, 22(11): 102-103.
19. 李瑩, 寧永明, 張春霖, 等. 唑來膦酸治療椎體成形術后殘余疼痛早期療效觀察. 中華創傷雜志, 2011, 27(5): 461-462.
20. 應潔靜, 朱曉影, 金掌, 等. 注射唑來膦酸結合經皮骨水泥椎體成形治療 OVCF 的療效. 浙江臨床醫學, 2016, 18(4): 597-599.
21. 倪力剛, 史曉林. 唑來磷酸鈉對椎體成形術后椎體再次骨折的影響. 杭州: 浙江省骨質疏松與骨礦鹽疾病學術年會暨《骨質疏松癥診治進展》專題研討班, 2012.
22. 朱曉波. 唑來膦酸聯合經皮椎體后凸成形術對老年椎體壓縮性骨折患者療效及骨密度、骨代謝影響. 藥物流行病學雜志, 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, Kyll?nen 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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