Efficacy and safety of different anti-osteoporotic drugs for the spinal fusion surgery: A network meta-analysis

BACKGROUND Administering anti-osteoporotic agents to patients perioperatively is a widely accepted approach for improving bone fusion rates and reducing the risk of complications.The best anti-osteoporotic agents for spinal fusion surgery remain unclear.AIM To investigate the efficacy and safety of different anti-osteoporotic agents in spinal fusion surgery via network meta-analysis.METHODS Searches were conducted in four electronic databases(PubMed,EMBASE),Web of Science,the Cochrane Library and China National Knowledge Infrastructure(CNKI)from inception to November 2022.Any studies that compared antiosteoporotic agents vs placebo for spinal fusion surgery were included in this network meta-analysis.Outcomes included fusion rate,Oswestry disability index(ODI),and adverse events.Network meta-analysis was performed by R software with the gemtc package.RESULTS In total,13 randomized controlled trials were included in this network metaanalysis.Only teriparatide(OR 3.2,95%CI:1.4 to 7.8)was more effective than placebo in increasing the fusion rate.The surface under the cumulative ranking curve(SUCRA)of teriparatide combined with denosumab was the highest(SUCRA,90.9%),followed by teriparatide(SUCRA,74.0%),zoledronic acid(SUCRA,43.7%),alendronate(SUCRA,41.1%)and risedronate(SUCRA,35.0%).Teriparatide(MD-15,95%CI:-28 to-2.7)and teriparatide combined with denosumab(MD-20,95%CI:-40 to-0.43)were more effective than placebo in decreasing the ODI.The SUCRA of teriparatide combined with denosumab was highest(SUCRA,90.8%),followed by teriparatide(SUCRA,74.5%),alendronate(SURCA,52.7),risedronate(SURCA,52.1%),zoledronic acid(SURCA,24.2%)and placebo(SURCA,5.6%)for ODI.The adverse events were not different between groups.CONCLUSION This network meta-analysis suggests that teriparatide combined with denosumab and teriparatide alone significantly increase the fusion rate and decrease the ODI without increasing adverse events.Based on current evidence,teriparatide combined with denosumab or teriparatide alone is recommended to increase the fusion rate and to reduce ODI in spinal fusion patients.

Evidence fusion procedure based on hybrid DSm model

Dezert-Smarandache（DSm） theory, a new information fusion theory, is widely applied in image processing, multiple targets tracking identification, and other areas for its excellent processing ability of imperfect information. However, earlier research on DSm theory mainly focused on one sort of questions. An evidence fusion procedure is proposed based on the hybrid DSm model to compensate for a lack of research on the entire information procedure of DSm theory. This paper analyzes the evidence fusion procedure, as well as correlative node input and output information. Key steps and detailed procedures of evidence fusion are also discussed. Finally, an experiment illustrates the efficiency of the proposed evidence fusion procedure.