Efficacy of zoledronic acid with percutaneous kyphoplasty/vertebroplasty in the treatment of osteoporotic vertebral compression fractures: a systematic review and meta-analysis
OBJECTIVE: The purpose of this study was to conduct a systematic review and meta-analysis analyzing the efficacy of zoledronic acid in improving outcomes with percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) surgeries for osteoporotic vertebral compression fracture (OVCF). MATERIALS AND METHODS: We electronically searched the databases of PubMed, Embase, ScienceDirect, CENTRAL, and Google Scholar up to 15th September 2020. All types of studies assessing the use of zoledronic acid with PKP/PVP surgeries were included. RESULTS: Seven studies were included. On meta-analysis of data from five studies reporting bone mineral density (BMD) as g/cm2, we found a statistically significant increase in BMD in the zoledronic group (MD: 0.14; 95% CI: 0.07, 0.21, I2=97%; p0.001). On pooled analysis of two studies reporting T scores, a similar result in favour of the zoledronic acid group was noted (MD: 0.60; 95% CI: 0.23, 0.98, I2=76%; p=0.002). We also found a statistically significant reduction in pain scores (MD: -1.23; 95% CI: -1.59, -0.86, I2=97%; p0.00001), ODI scores (MD: -9.54; 95% CI: -12.76, -6.31, I2=95%; p0.00001) and serum type I procollagen peptide (CTX) levels (MD: -0.19; 95% CI: -0.25, -0.12, I2=98%; p0.00001) with zoledronic acid as compared to control. Our analysis also found a significantly reduced risk of further vertebral fractures in patients receiving zoledronic acid as compared to control (RR: 0.17; 95% CI: 0.07, 0.39, I2=0%; p0.00001). CONCLUSIONS: Our review indicates that the use of once-yearly zoledronic acid in the peri-operative period of PVP/PKP procedures for patients with OVCF leads to significant improvement of BMD, reduced pain scores, better ODI scores, and reduced incidence of further vertebral fractures. Our results have clinical significance as it encourages the use of zoledronic acid for such patients for better clinical outcomes.
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机译：目的：本研究的目的是进行系统审查和荟萃分析，分析唑妥酸在改善具有经皮椎体（PVP）的结果中的疗效和骨质疏松椎体压缩骨折（OVCF）的经皮脑膜术（PKP）手术。材料和方法：我们以2020年9月15日将PubMed，Embase，ScieCentirect，Central和Google Scholar的数据库电子搜索了Pubmed，Embase，ScieCentirect，Central和Google Scholar的数据库。包括评估使用PKP / PVP手术的唑代酸的所有类型研究。结果：包括七项研究。关于从五项研究报告骨矿物密度（BMD）作为G / CM2的数据的Meta分析，我们发现Zoledronic基团中BMD的统计学显着增加（MD：0.14; 95％Ci：0.07,0.21，I2 = 97％ ; p <0.001）。关于报告T分数的两项研究的汇总分析，注意到Zoldronic酸基团的类似结果（MD：0.60; 95％Ci：0.23,0.98，I2 = 76％; P = 0.002）。我们还发现疼痛评分的统计学显着降低（MD：-1.23; 95％CI：-1.59，-0.86，I2 = 97％; P <0.00001），ODI评分（MD：-9.54; 95％CI：-12.76 ，-6.31，I2 = 95％; P <0.00001）和血清I型肽肽（CTX）水平（MD：-0.19; 95％CI：-0.25，-0.12，I2 = 98％; P <0.00001），P <0.00001）与ZOLEDRONIC与对照相比酸。我们的分析还发现，与对照（RR：0.17; 95％Ci：0.07,0.39，I2 = 0％; P <0.00001），发现接受唑膦酸的患者进一步降低椎体骨折的风险显着降低。结论：我们的审查表明，在卵菌夫患者的PVP / PKP程序中使用一次每年唑醇在PVP / PKP程序中导致BMD的显着改善，降低疼痛评分，更好的ODI评分，以及降低进一步椎体的发病率降低骨折。我们的结果具有临床意义，因为它鼓励使用唑妥酸的患者进行更好的临床结果。
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