Alendronate prevents femoral periprosthetic bone loss following total hip arthroplasty: Prospective randomized double-blind study

Abstract

Following total hip arthroplasty (THA), femoral periprosthetic bone undergoes a remodeling process that results in bone loss in its proximal regions that may compromise the long-term outcome of THA. Periprosthetic bone loss mainly occurs during the first postoperative months. The question is whether a postoperative treatment with alendronate is effective in reducing periprosthetic bone loss and which doses and duration of treatment are required. In a 12-month prospective, randomized double-blind study, 51 patients undergoing cementless THA were treated postoperatively either with a daily dose of 20 mg alendronate for 2 months and 10 mg for 2 months thereafter (group I), with 20 mg of alendronate for 2 months and 10 mg for 4 months thereafter (group II), or treated with placebo (group III). Proximal femoral bone mineral density (BMD) was measured with dual-energy X-ray absorptiometry (DEXA) and serum biochemical markers of bone turnover bone specific alkaline phosphatase, osteocalcin, and C-terminal telopeptides (CTX-I) were assayed. Six months of alendronate treatment significantly reduced ( p < 0.001) bone loss in proximal medial region (À10%) compared with placebo (À26%). All biochemical markers of bone turnover were suppressed by alendronate. These data suggest that alendronate administered for the first 6 postoperative months following THA was effective in preventing early periprosthetic bone loss. ß

Association of Bisphosphonate Use and Risk of Revision After THA: Outcomes From a US Total Joint Replacement Registry

“…Bisphosphonates have been evaluated with regard to prevention of bone loss surrounding THA implants in multiple studies [1,2,12,15,16,37,38]. The ability to help prevent bone loss surrounding THA implants suggests a clinically relevant tool for prevention of osteolysis and stress shielding around these devices and, ultimately, implant failure and revision surgery.…”

“…Inadequate quantity or quality of the supporting bone can contribute to THA failure, including aseptic loosening and periprosthetic fracture [27,28]. Multiple studies have evaluated the effect of bisphosphonate use on bone mineral density (BMD) surrounding THA devices [1,2,5,12,15,16,29,32,37,38]. All the studies focused on the short-term effect of a single antiosteoporotic agent on the BMD surrounding the implant.…”

Effect of Alendronate Combined With Alfacalcidol on the Biological Stability of Hip Joint Endoprosthesis in Patients With Systemic Osteoporosis

“…его способ-ность снижать интенсивность резорбции костной ткани убе-дительно доказана в клинической практике при лечении вы-сокооборотных форм системного остеопороза [8]. имеются также сообщения о его использовании у пациентов после операции эндопротезирования [5,6,23]. однако целесообраз-ность их применения в этих случаях по-прежнему воспри-нимается неоднозначно и есть данные [20], что алендронат не снижает интенсивности остеолиза вблизи компонентов эндопротеза.…”

Delayed Administration of Risedronate Does Not Restore Bone Loss In Patients Following Total Hip Arthroplasty - A randomized, double blinded clinical study

“…[30] With various numbers of enrolled subjects and different hip implants, other groups have definitely shown that an early treatment of bisphosphonate works well in preventing bone loss. [23,24,30,31,32,33] Those studies strongly suggest that oral bisphosphonate treatment may be one of the effective therapeutic options to improve bone strength in patients at an early administration following THA. They cannot however conclude effectiveness in the late administration following THA.…”