Meta-Analysis
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2023; 11(30): 7350-7362
Published online Oct 26, 2023. doi: 10.12998/wjcc.v11.i30.7350
Efficacy and safety of different anti-osteoporotic drugs for the spinal fusion surgery: A network meta-analysis
Xiao-Yuan He, Huan-Xiong Chen, Zhi-Rong Zhao
Xiao-Yuan He, Huan-Xiong Chen, Zhi-Rong Zhao, Spinal Surgery, Hainan Province Clinical Medical Center, Haikou 570100, Hainan Province, China
Author contributions: He XY He and Chen HX were responsible for research design, statistics and paper writing; Chen HX and Zhao ZR were responsible for the collation of data; all authors proofed the manuscript.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhi-Rong Zhao, PhD, Professor, Spinal Surgery, Hainan Province Clinical Medical Center, The First Affiliated Hospital of Hainan Medical University, No. 31 Longhua Road, Haikou 570100, Hainan Province, China. yinmaosu19930611@163.com
Received: August 17, 2023
Peer-review started: August 17, 2023
First decision: August 30, 2023
Revised: September 10, 2023
Accepted: September 28, 2023
Article in press: September 28, 2023
Published online: October 26, 2023
Processing time: 68 Days and 18.2 Hours
ARTICLE HIGHLIGHTS
Research background

Administering anti-osteoporotic agents to patients perioperatively is a widely accepted approach for improving bone fusion rates and reducing the risk of complications. The best anti-osteoporotic agents for spinal fusion surgery remain unclear.

Research motivation

This network meta-analysis suggests that teriparatide combined with denosumab and teriparatide alone significantly can increase the fusion rate and decreased the Oswestry disability index (ODI) without increasing adverse events.

Research objectives

The purpose of this study was to investigate the efficacy and safety of different anti-osteoporotic agents in spinal fusion surgery via network meta-analysis.

Research methods

Searches were conducted in four electronic databases (PubMed, EMBASE, Web of Science, the Cochrane Library and China National Knowledge Infrastructure (CNKI) from inception to November 2022. Any studies that compared anti-osteoporotic agents vs placebo for spinal fusion surgery were included in this network meta-analysis. Outcomes included fusion rate, ODI, and adverse events. Network meta-analysis was performed by R software with the gemtc package.

Research results

In total, 13 randomized controlled trials were included in this network meta-analysis. Only teriparatide (OR 3.2, 95%CI: 1.4 to 7.8) was more effective than placebo in increasing the fusion rate. The surface under the cumulative ranking curve (SUCRA) of teriparatide combined with denosumab was the highest (SUCRA, 90.9%), followed by teriparatide (SUCRA, 74.0%), zoledronic acid (SUCRA, 43.7%), alendronate (SUCRA, 41.1%) and risedronate (SUCRA, 35.0%). Teriparatide (MD -15, 95%CI: -28 to -2.7) and teriparatide combined with denosumab (MD -20, 95%CI: -40 to -0.43) were more effective than placebo in decreasing the ODI. The SUCRA of teriparatide combined with denosumab was highest (SUCRA, 90.8%), followed by teriparatide (SUCRA, 74.5%), alendronate (SURCA, 52.7), risedronate (SURCA, 52.1%), zoledronic acid (SURCA, 24.2%) and placebo (SURCA, 5.6%) for ODI. The adverse events were not different between groups.

Research conclusions

This network meta-analysis suggests that teriparatide combined with denosumab and teriparatide alone significantly increase the fusion rate and decrease the ODI without increasing adverse events. Based on current evidence, teriparatide combined with denosumab or teriparatide alone is recommended to increase the fusion rate and to reduce ODI in spinal fusion patients.

Research perspectives

Teriparatide combined with denosumab or teriparatide alone is recommended to increase the fusion rate and to reduce ODI in spinal fusion patients.