Knee osteoarthritis and fractures: potential beneficial role of bisphosphonates
- Autores: Daniel Prieto Alhambra
- Directores de la Tesis: Muhammad Kassim Javaid (dir. tes.), Rafael Azagra Ledesma (codir. tes.)
- Lectura: En la Universitat Autònoma de Barcelona ( España ) en 2011
- Idioma: español
- Tribunal Calificador de la Tesis: Vicent Fonollosa Pla (presid.), Silvano Adami (secret.), Jesús González Macías (voc.)
- Materias:
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- Resumen
PURPOSE Patients with knee osteoarthritis (KOA) have higher bone mass, but no corresponding decrease in fracture risk. We aimed to: 1.assess hip fracture rates in a cohort of patients undergoing a total knee replacement (TKR) due to KOA, and compare them to disease-free controls; and 2.study the effect of bisphosphonate use on post-TKR fracture risk.
METHODS From the General Practice Research Database, patients ¿40 years old who underwent a TKR due to KOA between 1986 and 2006 constituted the KOA cohort. Five disease-free controls were matched to them based on gender, age and practice were they were registered. For the first objective, Poisson Regression was used to calculate yearly hip fracture incidence, and to compare the KOA cohort to the matched controls and calculate Rate Ratios (RR). For the second aim, we identified those in the KOA cohort who were bisphosphonate users, and fitted Cox survival models to assess the effect of bisphosphonates on post-TKR fracture risk.
RESULTS Hip fracture rates were similar if not lower in the KOA cohort before TKR, and increased significantly in the first year after (RR 1.58 [95%CI 1.14 to 2.19]), declining until they equal controls in year 3 post-TKR.
KOA patients identified as bisphosphonate users are at lower post-surgery risk than non-users: HR 0.45 [95%CI 0.29 to 0.70].
DISCUSSION Patients with KOA are at up to 58% increased risk of hip fracture immediately after undergoing a TKR. Bisphosphonate use is related to a 55% decrease in post-surgery risk in these patients, and might play a therapeutic role. Randomized Controlled Trials should confirm the latter findings.
