The effects of pre-operative anti-osteoporotic use on total joint arthroplasty complications: A national database study

Luca Katz; Helen Zhang; Piper Ireland; Maguire Anuszewski; John D Milner; Jonathan Liu; Alan H Daniels; Valentin Antoci

doi:10.1016/j.jor.2024.11.002

The effects of pre-operative anti-osteoporotic use on total joint arthroplasty complications: A national database study

J Orthop. 2024 Nov 6:60:143-151. doi: 10.1016/j.jor.2024.11.002. eCollection 2025 Feb.

Authors

Luca Katz¹, Helen Zhang¹, Piper Ireland¹, Maguire Anuszewski¹, John D Milner², Jonathan Liu², Alan H Daniels², Valentin Antoci²

Affiliations

¹ The Warren Alpert Medical School of Brown University, Providence, RI, USA.
² Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, RI, USA.

PMID: 39583221
PMCID: PMC11582541 (available on 2026-02-01)
DOI: 10.1016/j.jor.2024.11.002

Abstract

Background: The current study aims to analyze the effect of pre-operative non-bisphosphonate anti-osteoporotic drugs on complication and revision rates following total joint arthroplasty (TJA).

Methods: A retrospective cohort analysis of the PearlDiver (PearlDiver Technologies, Colorado Springs, CO) database was performed. The database was queried to identify all patients who underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) with history of hip or knee osteoarthritis and either osteopenia or osteoporosis. The treatment groups consisted of patients prescribed non-bisphosphonate and bisphosphonate osteomodulatory agents for 1 year prior to and following surgery. The treatment groups were matched to control cohorts by age, gender, and comorbidities. Chi-square analyses were used to compare outcomes between paired cohorts.

Results: There were no statistically significant differences (p ≤ 0.05) in risk of aseptic loosening, broken prosthesis, dislocation of prosthetic joint, periprosthetic fracture, periprosthetic osteolysis, postoperative infection, full or partial revision, or stress fracture between both the non-bisphosphonate and bisphosphonate groups following THA or TKA. Comparisons between both groups and control cohort also yielded no significant differences.

Conclusion: The current study detected no significant differences in early post-operative complications following TJA between patients treated with different classes of anti-osteoporotic medications versus untreated osteopenic/osteoporotic patients. Further research is required to fully understand the impact of osteomodulatory medications on TJA outcomes. Analysis should continue to ensure a high-quality standard of care and aim to better understand outcomes for such patients requiring TJA.

Keywords: Arthroplasty; Bisphosphonates; Complication; Osteomodulatory agents; Osteoporosis; Revision.