Alendronate in the treatment of avascular necrosis of the hip

Abstract

Alendronate in the treatment of avascular necrosis of the hip SIR, Avascular necrosis (AVN) of the bone results from decreased blood supply to the bone, resulting in bone death. The most common site is the head of the femur. AVN is characterized by persistent, often nagging and disabling pain associated with significant reduction in joint movement and mobility. The condition tends to run a progressively downhill course. Medical and surgical management generally aims to improve the blood supply by vasodilators and antiplatelet drugs or by physically drilling holes and bone grafting to restore the blood supply to the avascular area. Eighty-five per cent of patients with symptomatic AVN progress to endstage disease over a 2-yr period [1]. So far, there is no universally accepted treatment that relieves pain and halts its progression. In this communication we report our early experience with the use of alendronate, a bisphosphonate, in AVN of the hip. All cases of proven AVN seen by us between February and October 2000 were assessed. All grades of AVN were considered eligible. Patients were excluded if they had one or more of the following: inability to be followed up regularly, symptoms of oesophagitis or gastritis, age below 18 yr, lactation, and abnormal renal, liver or bone profile. Besides routine physical examination, parameters specifically studied were range of motion, standing and walking time in minutes, pain on visual analogue scale of 0-10 (0, no pain; 10, maximum possible pain) and disability on a scale of 0-10 (0, no disability; 10, totally handicapped). Baseline investigations included complete blood count, liver, renal and bone profiles, Serum 25 (hydroxy) vit D 3 and magnetic resonance imaging (MRI) of both hips. MRI was staged according to the classification of Mitchell et al. [2]. If both hips were affected, for MRI staging the stage of the maximally affected hip was used for analysis. All patients received alendronate 10 mguday plus a calcium supplement of 1 guday. Oral vitamin D 3 was administered to patients

Association between bisphosphonates and jaw osteonecrosis: A study in Wistar rats

“…It is suspected that smoking, 32 chronic use of alcohol, 32,36 diabetes mellitus, 11 hypoproteinemia, 4 corticotherapy, chemotherapy, 6,12,14,15,37,38 immunosuppressive therapy, 12,36 endodontic lesions, periodontal disease, abscesses, 9 poor oral hygiene, 32 and renal insufficiency 27 are cofactors in the development of osteonecrosis by bisphosphonates. Therefore, it is necessary to consider that in the case of alendronate, 1 or more cofactors could exert an essential role in the development of osteonecrosis.…”

Possible beneficial effect of bisphosphonates in osteonecrosis of the knee

“…There are several reports of successful bisphosphonate treatment of the transient osteoporosis of the hip or osteonecrosis of the femoral head [1,2,14,29,36,37,43,50]. In an uncontrolled clinical study, 16 patients with avascular necrosis of the hip were treated with alendronate and an improvement in pain, disability and function compared to the expected natural history of the disease was found [3]. In a recently published observation from the same authors of 395 hips with avascular necrosis which were treated with alendronate for 3 years with a mean follow-up of 4 years improvement in the clinical function, a reduction in the rate of collapse and a decrease in the requirement for total hip replacement, compared with the findings of other studies in which no treatment was given [2].…”

Alendronate is more effective than elcatonin in improving pain and quality of life in postmenopausal women with osteoporosis

“…Although changes in urinary NTX did not have any significant correlation with changes in FSS in the present study, one possibility for the mechanisms may be concerned with bone resorption, because the efficacy of bisphosphonates for bone pain in patients with bone resorption-related diseases has been demonstrated. Agarwala et al [33] reported that short-term treatment with ALN improved pain, disability, and standing and walking capacity in patients with avascular necrosis of the hip, due to inhibition of the resorptive action of mature osteoclasts, an increase in apoptosis of osteoclasts, and probably a decrease in apoptosis of osteoblasts and osteocytes. Intravenous pamidronate seems to be a valuable treatment for back pain, as well as rehabilitating elderly patients suffering from chronic and refractory back pain due to osteoporotic vertebral fractures [34], and also for reduction of skeletal pain and biochemical markers of bone resorption in patients with skeletal metastases [35][36][37].…”