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• W2083770112 abstract "We read with interest the article, ‘‘A meta-analysis of bisphosphonates for periprosthetic bone loss after total joint’’, which was based on 17 randomized controlled trials (RCTs) involving 781 patients to evaluate the effect of bisphosphonates (BPs) [1]. Respecting the highly influential status of meta-analysis in the hierarchy of evidence, we wish to bring attention to three important issues. First, the authors adopted the change from baseline (MD) in bone mineral density (BMD, g/cm ) values in order to reduce the bias of different baselines. However, time-point values or percentage changes of BMD are more appropriate as the standard deviations (S) of absolute change values (SD, g/cm ), which were not directly provided in all of the studies included. Furthermore, it is obviously unacceptable to impute the missing SD using S of baseline data (S0) since they are totally different statistical concepts [2]. Statistically, it will widen the 95 % confidential interval (CI) of effect sizes in each study and underestimate the power of overall effects, leading to some unexpected insignificant results. With great concern over this, we are encouraged to impute the missing SD values following the instruction of Cochrane handbook 5.0.2 [2]. The SD in four articles were imputed by the formula, SD = MD/t, as t value for MD were achievable (data not shown). The correlation coefficients (Corr) were also calculated to assess the reliability of MD. Due to the same measurement scale (g/cm), the same time-points, and the consistent MD (Corr [ 0.5), which were very reliable as changes from baseline, the imputed SD in BPs and control groups from Soininvaara’s study [3] was tentatively adopted for other studies. The reason why we picked Soininvaara’s study was its median imputed SD and its similar Corr value between the BPs and control groups (Table 1). Second, compared to previous meta-analysis [4, 5], the most distinct perspective of this article is its subgroup analysis. The authors concluded from their subgroup analysis that the efficacy of BPs in the gender-balanced, shorter duration, and non-nitrogenous BPs groups was not different from that for controls. However, in this metaanalysis, the results of their subgroup analysis should be treated with greater caution, mainly due to imbalanced number of studies between subgroups. Furthermore, these results were confounded by many potential influential factors in the meantime, including varied surgeries, prosthesis, BPs, durations of treatment, and calcium supplementation across studies, which needed further stratification and identification. For example, there were only three studies [6–8] in the ‘‘gender-balanced group’’ subgroup of 6 months (cut-off value: M:F = 1), of which two studies [6, 7] were also presented in the subgroup ‘‘shorter duration’’ (cut-off value: 6 months, 3 studies [6, 7, 9] in total); a similar situation existed in the 12-month group as This comment refers to the article available at doi:10.1007/s00776-013-0411-4." @default.
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• W2083770112 date "2014-01-01" @default.
• W2083770112 modified "2023-09-24" @default.
• W2083770112 title "Influential factors in bisphosphonates for periprosthetic bone loss after total joint arthroplasty" @default.
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• W2083770112 doi "https://doi.org/10.1007/s00776-013-0500-4" @default.
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