Denosumab after total hip arthroplasty – Authors’ reply

and for their assessment of the value of our findings for the development of a non-surgical treatment for osteolysis after joint replacement. As arthroplasty surgeons, we are highly sensitive to the issue of periprosthetic infection risk that represents a disastrous patient outcome after joint replacement. However, in the meta-analysis of all clinical trials of denosumab (60 mg dose, 33 studies [including the FREEDOM trial referred to by the correspondents], 22 253 patients) by Diker-Cohen and colleagues,

there was no reported difference in the relative risk of any infection (denosumab vs placebo 1·03, 95% CI 0·99–1·06) nor infection-related mortality (0·55, 0·20–1·23) between treatment groups. As such, we find this reassuringly in support of the safety of denosumab for use in the setting of osteolysis.