| Objective:The purpose of this study is to analyze the efficacy of anti-bone resorption and osteogenesis drugs on the clinical recovery of hip fracture patients,and guide clinical treatment.Methods:1.We selected 57 elderly osteoporotic hip fracture patients admitted to our department from January 2017 to January 2019 through clinical retrospective analysis,including 23 patients who were treated with anti-osteoporosis after surgery,other 34 patients were not treated by anti-osteoporosis.The two groups of patients were compared in gender,age,fracture types and BMD,and compared the hip harris score,pain VAS score,and re-fracture rate of the two groups one year after surgery.Finally,analyze the effect of anti-osteoporosis treatment on the hip fracture patients;2.Using keywords and theme words to retrieve relevant literatures in all databases including Cochrane Library,Pubmed,Embase,CBM,CNKI,and Wanfang Database,then selected literatures of RCT and high quality clinical review study,the analysis model(fixed/random)is determined by I2 statistical values,meta analysis process uses Cochrane RevMan 5.3 software version.Outcomes include hip fracture healing time,hip harris score,bone mineral density,bone turnover markers,and re-fracture rate.Results:1.There were 23 patients in anti-osteoporosis group,including 9 males,14 females,8 femoral neck fractures,15 femoral intertrochanteric fractures,average age was(75.48±7.77)years and lumbar BMD was(0.66±0.05)g/cm2.34 patients in non anti-osteoporosis group,including 12 males,22 females,14 femoral neck fractures,20 femoral intertrochanteric fractures,average age was(78.59±8.65)years and lumbar BMD was(0.67±0.07)g/cm2.There was no statistical difference in gender,fracture type,age,and BMD between the two groups(P>0.05).The HHS of anti-osteoporosis group was(76.84±4.03)points,non anti-osteoporosis group was(71.70±5.28)points;The pain VAS score of the anti-osteoporosis group was(2.16±0.60)points,non anti-osteoporosis group was(2.89±0.89)points.There was statistical difference in HHS and VAS score between the two groups(P<0.05).The rate of re-fracture in anti-osteoporosis group was 10.5%,non anti-osteoporosis group was 18.5%.There was no statistical difference(P>0.05).2.A total of 19 articles were included in two meta analyses,meta analysis shows that treatment with bisphosphate has no significant effect on the healing time of hip fracture(weeks)[MD=-0.84,95%CI(-2.53,0.85),P=0.33]and hip harris score[MD=2.64,95%CI(-1.19,6.46),P=0.18],significantly improve bone mineral density after hip fracture(g/cm2)[MD=0.10,95%CI(0.09,0.11),P<0.05],reduce serum levels of β-CTX after fracture(ng/ml)[MD=-0.15,95%CI(-0.16,-0.14),P<0.05],decrease the rate of re-fracture[RR=0.62,95%CI(0.50,0.79),P<0.05],descriptive analysis shows that bisphosphate can reduce hip fracture mortality and alleviate pain symptoms;Calcitonin does not significantly reduce the re-fracture rate in hip fracture patients[RR=0.34,95%CI(0.10,1.19),P=0.09],descriptive analysis shows that calcitonin can reduce periprosthetic ectopic ossification and improve hip function;Osteogenic drug teriparatide can significantly shorten the healing time of hip fracture(weeks)[MD=-3.53,95%CI(-5.52,-1.54),P<0.05],improve hip harris score[MD=6.54,95%CI(2.93,10.14),P<0.05],increase bone mineral density(g/cm2)[MD=0.06,95%CI(0.04,0.07),P<0.05],has no significant effect on the the serum PINP level(ng/ml)[MD=31.75,95%CI(-4.37,67.87),P=0.08]and re-fracture rate[RR=0.71,95%CI(0.44,1.14),P=0.16],descriptive analysis shows that teriparatide can significantly reduce pain and complications.Conclusions:Osteoporosis affects the rehabilitation efficacy of hip fracture patients,different drugs have different clinical effects on hip fracture patients.Anti-osteoporosis treatment has significant clinical benefits in shortening the healing time of hip fracture,improving HHS,improving BMD,regulating bone turnover markers,reducing pain and re-fracture rate.Paying attention to anti-osteoporosis treatment is helpful to improve the functional recovery of patients with hip fracture. |
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