The association between bisphosphonate use and aseptic revision risk in primary elective shoulder arthroplasty

Abstract Background The total joint literature has shown promising results of bisphosphonate use on decreasing early bone loss after hip and knee arthroplasty and reducing aseptic revision risk though a higher risk of periprosthetic fracture has also been reported. We sought to evaluate the association between bisphosphonate use and aseptic revision risk in patients undergoing shoulder arthroplasty. Methods A US integrated healthcare system's registry was used to identify 6204 patients who underwent primary elective shoulder arthroplasty for osteoarthritis (2005-2016). Preoperative bisphosphonate users (defined as having at ≥6-month supply and 80% adherence) were compared to nonbisphosphonate users. Multivariable Cox proportional hazard regression was used to evaluate aseptic revision risk according to bisphosphonate use while adjusting for confounders. Secondary analysis stratified by age (40-64, ≥65 years) and bone quality status (normal, osteopenia, osteoporosis, or unknown). Results At the time of index procedure, 564 (9.1%) were considered as bisphosphonate users. We failed to observe a difference in aseptic revision risk by bisphosphonate use (hazard ratio = 0.92, 95% confidence interval = 0.50-1.72). No association was observed even after stratifying by bone quality and age. No revisions for periprosthetic fracture occurred in the bisphosphonate user group during follow-up. Conclusions While prior studies in lower extremity joint arthroplasty cohorts have observed a differential risk for revision surgery with bisphosphonate use, we failed to observe any associations between bisphosphonate use and revision risk in a cohort of shoulder arthroplasty patients. Level of Evidence Level III; Retrospective Cohort Comparative Study