Determining the most effective osteoporosis drug for bone mineral density loss in proximal area after total hip arthroplasty: A network meta-analysis

The aim of this study was to compare and rank the efficacy of different drugs for bone mineral density (BMD) loss prevention at 1 year after total hip arthroplasty (THA) using a network meta-analysis (NMA) of randomized controlled trials (RCTs). A literature search was conducted based on the PRISMA statement. The searched databases included MEDLINE (through PubMed), Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing & Allied Health Literature (CINAHL). Only RCTs exploring the efficacy of currently available osteoporosis drugs in preventing periprosthetic BMD loss were included. A multivariate random-effects NMA was conducted to combine direct and indirect comparisons of agents using a frequentist consistency model. Regarding the efficacy rank, the frequentist analog to the surface under the cumulative ranking (SUCRA) probabilities, called the P-score, was used. In total, 17 RCTs were extracted. According to the pairwise mean difference (95% confidence interval) in BMD change, the efficacy of teriparatide was highest in both zones 1 and 7. From the predicted treatment rankings for BMD changes, teriparatide was ranked as the best intervention in zone 1 (P-score ​= ​0.8844) and zone 7 (P-score ​= ​0.9044) The results suggest that teriparatide, zoledronic acid, alendronate, and etidronate may be options for the prevention of periprosthetic BMD loss in zones 1 and 7 ​at 1 year after THA. • Teriparatide, zoledronic acid, alendronate, and etidronate prevent BMD loss after THA. • The overall certainty of the evidence was low to moderate.