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Fracture risk before and after total hip replacement in patients with osteoarthritis: potential benefits of bisphosphonate use

Fracture risk before and after total hip replacement in patients with osteoarthritis: potential benefits of bisphosphonate use
Fracture risk before and after total hip replacement in patients with osteoarthritis: potential benefits of bisphosphonate use
OBJECTIVE: The association between osteoarthritis (OA) and fractures remains unclear. OA patients have increased bone mass, but no corresponding decrease in fracture rate. This study was undertaken to determine the fracture rates in patients with hip OA undergoing a total hip replacement (THR), as compared with disease-free controls, and to assess the association between bisphosphonate use and postsurgery fracture risk.

METHODS: We conducted a population-based parallel-cohorts study. All patients in the UK General Practice Research Database undergoing a THR for hip OA between 1986 and 2006 constituted the exposed cohort (n = 14,133). Five disease-free controls were matched with each patient by age, sex, and practice site. Subjects were followed up for 5 years before and after surgery. Fracture rates and rate ratios (RRs) were estimated using Poisson regression. In addition, bisphosphonate use was identified among patients undergoing THR, and the data, stratified by the presence or absence of a previous fracture and by treatment propensity score, were assessed using fitted Cox models to study the effect of bisphosphonate use on the risk of fracture postsurgery.

RESULTS: Patients undergoing a THR had a similar fracture risk as that in controls in the 5 years before THR, but had higher rates postsurgery, which peaked at years 2.5-5 (adjusted RR 1.24, 95% confidence interval [95% CI] 1.02-1.52). Use of bisphosphonates lowered the fracture risk among THR patients who received bisphosphonates as primary prevention (hazard ratio [HR] 0.56, 95% CI 0.38-0.82) and also among THR patients who had experienced a previous osteoporotic fracture (HR 0.48, 95% CI 0.23-0.99).

CONCLUSION: This study identified a 25% increase in fracture risk at 2.5-5 years postsurgery among patients undergoing a THR. Bisphosphonate use reduced the post-THR risk of fracture when administered both as primary prevention and as secondary prevention, by 44% and 52%, respectively. This must be further confirmed in randomized controlled trials
0004-3591
992-1001
Prieto-Alhambra, Daniel
e596722a-2f01-4201-bd9d-be3e180e76a9
Javaid, M. Kassim
64155236-2ef0-4065-b684-cf723a888117
Judge, Andrew
b853f89f-dc44-428e-9fe2-35e925544abe
Maskell, Joe
f10981fc-239d-4a91-acb6-d71cb9586529
Kiran, Amit
4b4006e4-c155-408b-ac66-6342c7b3d0ee
de Vries, Frank
10245a32-6083-4feb-9d20-7e7db0f358b1
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Arden, Nigel K.
23af958d-835c-4d79-be54-4bbe4c68077f
Prieto-Alhambra, Daniel
e596722a-2f01-4201-bd9d-be3e180e76a9
Javaid, M. Kassim
64155236-2ef0-4065-b684-cf723a888117
Judge, Andrew
b853f89f-dc44-428e-9fe2-35e925544abe
Maskell, Joe
f10981fc-239d-4a91-acb6-d71cb9586529
Kiran, Amit
4b4006e4-c155-408b-ac66-6342c7b3d0ee
de Vries, Frank
10245a32-6083-4feb-9d20-7e7db0f358b1
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Arden, Nigel K.
23af958d-835c-4d79-be54-4bbe4c68077f

Prieto-Alhambra, Daniel, Javaid, M. Kassim, Judge, Andrew, Maskell, Joe, Kiran, Amit, de Vries, Frank, Cooper, Cyrus and Arden, Nigel K. (2011) Fracture risk before and after total hip replacement in patients with osteoarthritis: potential benefits of bisphosphonate use. Arthritis & Rheumatism, 63 (4), 992-1001. (doi:10.1002/art.30214). (PMID:21452321)

Record type: Article

Abstract

OBJECTIVE: The association between osteoarthritis (OA) and fractures remains unclear. OA patients have increased bone mass, but no corresponding decrease in fracture rate. This study was undertaken to determine the fracture rates in patients with hip OA undergoing a total hip replacement (THR), as compared with disease-free controls, and to assess the association between bisphosphonate use and postsurgery fracture risk.

METHODS: We conducted a population-based parallel-cohorts study. All patients in the UK General Practice Research Database undergoing a THR for hip OA between 1986 and 2006 constituted the exposed cohort (n = 14,133). Five disease-free controls were matched with each patient by age, sex, and practice site. Subjects were followed up for 5 years before and after surgery. Fracture rates and rate ratios (RRs) were estimated using Poisson regression. In addition, bisphosphonate use was identified among patients undergoing THR, and the data, stratified by the presence or absence of a previous fracture and by treatment propensity score, were assessed using fitted Cox models to study the effect of bisphosphonate use on the risk of fracture postsurgery.

RESULTS: Patients undergoing a THR had a similar fracture risk as that in controls in the 5 years before THR, but had higher rates postsurgery, which peaked at years 2.5-5 (adjusted RR 1.24, 95% confidence interval [95% CI] 1.02-1.52). Use of bisphosphonates lowered the fracture risk among THR patients who received bisphosphonates as primary prevention (hazard ratio [HR] 0.56, 95% CI 0.38-0.82) and also among THR patients who had experienced a previous osteoporotic fracture (HR 0.48, 95% CI 0.23-0.99).

CONCLUSION: This study identified a 25% increase in fracture risk at 2.5-5 years postsurgery among patients undergoing a THR. Bisphosphonate use reduced the post-THR risk of fracture when administered both as primary prevention and as secondary prevention, by 44% and 52%, respectively. This must be further confirmed in randomized controlled trials

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Published date: April 2011

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Local EPrints ID: 181485
URI: http://eprints.soton.ac.uk/id/eprint/181485
ISSN: 0004-3591
PURE UUID: bcb86a73-08f3-45ca-ad3f-777b25ab3325
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 14 Apr 2011 10:01
Last modified: 18 Mar 2024 02:45

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Contributors

Author: Daniel Prieto-Alhambra
Author: M. Kassim Javaid
Author: Andrew Judge
Author: Joe Maskell
Author: Amit Kiran
Author: Frank de Vries
Author: Cyrus Cooper ORCID iD
Author: Nigel K. Arden

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