BACKGROUND: The clinical application of zoledronic acid in the treatment of
osteoporosis lacks systematic scientific evaluation and evidence-based basis.
Therefore, the clinical efficacy of zoledronic acid combined with percutaneous
kyphoplasty in the treatment of osteoporotic vertebral compression fracture is
still uncertain.
OBJECTIVE: To systematically evaluate the
efficacy of zoledronic acid combined with percutaneous kyphoplasty in the
treatment of osteoporotic vertebral compression fracture.
METHODS: A computer search of all randomized
controlled studies and clinical trials of zolidronic acid combined with
percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression
fracture published in CNKI, Wanfang, VIP, CBM, PubMed and Cochrane prior to
September 2019 was performed. The experimental group was treated with
zoledronic acid and percutaneous kyphoplasty, while the control group was
treated with percutaneous kyphoplasty. Literature screening and data extraction
were conducted by the two researchers independently. The quality of the
included randomized controlled trials was evaluated one by one according to the
Cochrane collaboration standards. Meta-analysis was performed on RevMan 5.3 for
those that met the inclusion criteria.
RESULTS AND CONCLUSION: (1) Five randomized
controlled trials were included, including 175 in the experimental group and
184 in the control group. (2) Meta-analysis results showed that the bone
mineral density was higher in the experimental group than in the control group
[MD=0.12, 95%CI(0.08, 0.17), P <
0.000 01]. The visual analogue scale score was lower in the experimental group
than that of the control group 6 and 12 months after treatment [MD=0.46, 95%CI(0.18, 0.75), P=0.002; MD=0.85, 95%CI(0.20, 1.50), P=0.01].
At 1 year after treatment, Oswestry disability index was lower in the
experimental group than in the control group [MD=6.59, 95%CI(4.77,8.41), P < 0.000 01]. Bone
cement leakage rate and recurrence rate of vertebral fractures were lower in
the experimental group than in the control group [OR=0.22, 95%CI(0.08,
0.59), P=0.003; OR=0.18, 95%CI(0.07,
0.50), P=0.000 8]. Vertebral height
recovery and kyphotic Cobb angle were not significantly different between the
two groups [MD=0.65, 95%CI(-0.27, 1.56), P=0.16; MD=-0.60, 95%CI(-2.45, 1.25), P=0.53]. (3) Results showed that
compared with percutaneous kyphoplasty alone, zoledronic acid combined with
percutaneous kyphoplasty has significant advantages in improving bone mineral
density, reducing the recurrence rate of vertebral fracture, improving the
long-term clinical symptoms of patients, preventing the bone cement leakage,
but a large number of high-quality multi-center randomized controlled studies
are still needed to provide more sufficient evidence in the later stage.