Table 11. Effect of bisphosphonate treatment on blood loss during elective orthopaedic surgery.

Risk-benefit balance The data on blood loss in patients who have and have not had bisphosphonate treatment prior to elective orthopaedic or spinal surgery are conflicting and difficult to interpret. Quality of evidence Very low Patient values and preferences Prevention of blood loss during surgery is likely to be valued by patients with PDB. If treatment strategies could be identified that were effective in preventing blood loss during elective orthopaedic surgery, it is likely that they would be favoured by patients. Costs and use of resources Bisphosphonates are inexpensive but intravenous therapy involves additional support costs and costs in terms of patient time attending for the infusion which may need to be considered. Recommendation There is insufficient evidence that bisphosphonate therapy reduces perioperative blood loss during elective orthopaedic surgery and they are not recommended for this indication.