{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T22:59:18Z","timestamp":1781045958821,"version":"3.54.1"},"reference-count":18,"publisher":"Georg Thieme Verlag KG","issue":"08","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Knee Surg"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Bisphosphonates have been the gold standard for osteoporosis treatment in the past decade. However, other medications available on the market are also valuable in the treatment of osteoporosis. Knowledge is limited regarding the incidence of postoperative complications following total knee arthroplasty (TKA) for patients taking these osteoporosis medications. Therefore, our primary objective was to examine the incidence of post-TKA complications in patients taking denosumab, selective estrogen receptor modulators (SERMs), teriparatide, or bisphosphonates at 90 days, 1 year, and 2 years. Our secondary objective was to examine the odds of post-TKA complications in patients taking denosumab, SERMs, or teriparatide, at 90 days, 1 year, and 2 years compared with bisphosphonates. Employing a retrospective cohort design, we used an all-payer national database to identify 28,514 post-TKA osteoporotic patients from 2015 to 2022 taking either bisphosphonates, denosumab, SERMs, or teriparatide. Postoperative complications investigated for each osteoporosis medication included prosthetic joint infection (PJI), surgical site infection, aseptic revision, manipulation under anesthesia, aseptic loosening, venous thromboembolism, and periprosthetic fracture. There was a higher incidence of aseptic revision in post-TKA patients taking denosumab (1.2 vs. 0.6%, 0.7%, 0.9%, p\u2009=\u20090.033) compared with patients taking bisphosphonates, SERMs, or teriparatide, respectively, at 90 days. There was a higher incidence of PJI (0.5 vs. 0.1%, 0%, 0.1%, p\u2009=\u20090.049) and aseptic revision (0.3 vs. 0.01%, 0.1%, 0.1%, p\u2009=\u20090.030) in post-TKA patients taking teriparatide compared with patients taking bisphosphonates, denosumab, or SERM's at 90 days and 1 year, respectively. After multivariate analysis with bisphosphonates set as the control, denosumab showed higher odds of aseptic revision at 90 days (odds ratio [OR]\u2009=\u20092.17, p\u2009=\u20090.007), and teriparatide showed higher odds of PJI at 90 days (OR\u2009=\u20093.46, p\u2009=\u20090.043) and aseptic loosening at 1 year (OR\u2009=\u20095.82, p\u2009=\u20090.026). Teriparatide and denosumab were associated with a higher incidence and odds of certain post-TKA complications compared with bisphosphonates. Our results indicate that bisphosphonates and SERMs are associated with the fewest post-TKA complications, but more studies are needed to appreciate the effectiveness of each medication.<\/jats:p>","DOI":"10.1055\/a-2779-0300","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T23:58:52Z","timestamp":1768607932000},"page":"434-439","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Osteoporosis Medications on Postoperative Complications Following Total Knee Arthroplasty"],"prefix":"10.1055","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0403-1675","authenticated-orcid":false,"given":"Emily Margaret","family":"Pilc","sequence":"additional","affiliation":[{"name":"Eastern Virginia Medical School at Old Dominion University, Norfolk, Virginia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza Morshed","family":"Katanbaf","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Lifebridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabrielle Nicole","family":"Swartz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Lifebridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Over","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Lifebridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Dubin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Lifebridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Whitney Anne","family":"Pettijohn","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Lifebridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5651-2625","authenticated-orcid":false,"given":"Ronald Emilio","family":"Delanois","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Lifebridge Health, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nirav K.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"issue":"07","key":"ref1","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1016\/j.arth.2019.03.044","article-title":"Osteoporosis is common and undertreated prior to total joint arthroplasty","volume":"34","author":"J T Bernatz","year":"2019","journal-title":"J Arthroplasty"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.artd.2022.02.003","article-title":"Bisphosphonates in total joint arthroplasty: a review of their use and complications","volume":"14","author":"C L McDonald","year":"2022","journal-title":"Arthroplast Today"},{"issue":"10","key":"ref3","doi-asserted-by":"crossref","first-page":"e0139927","DOI":"10.1371\/journal.pone.0139927","article-title":"Bisphosphonate use and risk of implant revision after total hip\/knee arthroplasty: a meta-analysis of observational studies","volume":"10","author":"S Teng","year":"2015","journal-title":"PLoS One"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"580","DOI":"10.1016\/j.knee.2019.12.010","article-title":"Denosumab prevents periprosthetic bone mineral density loss in the tibial metaphysis in total knee arthroplasty","volume":"27","author":"Y Murahashi","year":"2020","journal-title":"Knee"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"185","DOI":"10.11005\/jbm.2022.29.3.185","article-title":"The efficacy of selective estrogen receptor modulators monotherapies in postmenopausal women with osteopenia","volume":"29","author":"K W Kim","year":"2022","journal-title":"J Bone Metab"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1345\/aph.1D353","article-title":"Teriparatide for severe osteoporosis","volume":"38","author":"K A Cappuzzo","year":"2004","journal-title":"Ann 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Syst"},{"issue":"01","key":"ref13","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s11657-023-01227-9","article-title":"Zoledronic acid and denosumab for periprosthetic bone mineral density loss after joint arthroplasty: a systematic review and meta-analysis of randomized controlled trials","volume":"18","author":"X Li","year":"2023","journal-title":"Arch Osteoporos"},{"issue":"04","key":"ref14","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1111\/os.12696","article-title":"Raloxifene prevents early periprosthetic bone loss for postmenopausal women after uncemented total hip arthroplasty: a randomized placebo-controlled clinical trial","volume":"12","author":"L Gong","year":"2020","journal-title":"Orthop Surg"},{"issue":"03","key":"ref15","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1080\/17453674.2017.1300746","article-title":"Denosumab reduces early migration in total knee replacement","volume":"88","author":"H Ledin","year":"2017","journal-title":"Acta Orthop"},{"issue":"05","key":"ref16","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1007\/s40258-013-0047-8","article-title":"Cost effectiveness of denosumab versus oral bisphosphonates for postmenopausal osteoporosis in the US","volume":"11","author":"A Parthan","year":"2013","journal-title":"Appl Health Econ Health Policy"},{"issue":"02","key":"ref17","doi-asserted-by":"crossref","first-page":"135","DOI":"10.2174\/1574884711308020006","article-title":"The discovery and development of selective estrogen receptor modulators (SERMs) for clinical practice","volume":"8","author":"P Y Maximov","year":"2013","journal-title":"Curr Clin Pharmacol"},{"issue":"02","key":"ref18","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1007\/s40273-020-00965-9","article-title":"An updated systematic review of cost-effectiveness analyses of drugs for osteoporosis","volume":"39","author":"N Li","year":"2021","journal-title":"PharmacoEconomics"}],"container-title":["The Journal of Knee Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2779-0300.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T22:37:46Z","timestamp":1781044666000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2779-0300"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,16]]},"references-count":18,"journal-issue":{"issue":"08","published-online":{"date-parts":[[2026,6,9]]},"published-print":{"date-parts":[[2026,7]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2779-0300","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["1538-8506","1938-2480"],"issn-type":[{"value":"1538-8506","type":"print"},{"value":"1938-2480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,16]]}}}