No effect of risedronate on femoral periprosthetic bone loss following total hip arthroplasty

Abstract

Background and purpose We have previously shown that during the first 2 years after total hip arthroplasty (THA), periprosthetic bone resorption can be prevented by 6 months of risedronate therapy. This follow-up study investigated this effect at 4 years.Patients and methods A single-center, double-blind, randomized placebo-controlled trial was carried out from 2006 to 2010 in 73 patients with osteoarthritis of the hip who were scheduled to undergo THA. The patients were randomly assigned to receive either 35 mg risedronate or placebo orally, once a week, for 6 months postoperatively. The primary outcome was the percentage change in bone mineral density (BMD) in Gruen zones 1 and 7 in the proximal part of the femur at follow-up. Secondary outcomes included migration of the femoral stem and clinical outcome scores.Results 61 of the 73 patients participated in this 4-year (3.9- to 4.1-year) follow-up study. BMD was similar in the risedronate group (n = 30) and the placebo group (n = 31). The mean difference was −1.8% in zone 1 and 0.5% in zone 7. Migration of the femoral stem, the clinical outcome, and the frequency of adverse events were similar in the 2 groups.Interpretation Although risedronate prevents periprosthetic bone loss postoperatively, a decrease in periprosthetic BMD accelerates when therapy is discontinued, and no effect is seen at 4 years. We do not recommend the use of risedronate following THA for osteoarthritis of the hip.

Short to Midterm Follow-Up of Periprosthetic Bone Mineral Density after Total Hip Arthroplasty with the Ribbed Anatomic Stem

“…Many nonimplant-related factors including age, sex, BMI, primary disease, bone quality, osteoporosis treatment, and daily activity might have potential impact on periprosthetic bone remodeling [72][73][74], although subgroup analyses indicated no correlation between periprosthetic BMD change and primary disease or BMI. Noticeably, bone remodeling around prosthesis in the patients with AVN will be permanently influenced by primary disease [75], the difference might be gradually increased in long-term follow-up, and antiosteoporosis therapy should be highly recommended in this population.…”

The efficiency of risedronate in reducing bone resorption after total hip arthroplasty: a meta-analysis of randomized control trials at a minimum of 6 months’ follow-up

“…No gray literature was included. Finally, four RCTs [ 14 – 17 ] published between 2006 and 2015 were included in the present meta-analysis; these studies included 97 patients in the experimental groups and 101 patients in the control groups. The duration follow-up ranged from 6 months to 4 years.…”

“…All studies reported allocation concealment by closed envelope or other techniques. Double blinding was reported in two RCTs [ 16 , 17 ]; however, none of the included studies attempted to blind the assessors. An intention-to-treat analysis was not performed in any of the RCTs; therefore, a potential risk of type II statistical error existed.…”

“…BMD in Gruen zone 4 at 6 months after THA was reported in four articles [ 14 – 17 ]. A fixed effects model was applied because no significant heterogeneity was found among these studies ( χ 2 = 3.79, df = 3, I 2 = 20.9%, P = 0.285).…”

“…Four studies [ 14 – 17 ] reported the advent events of nausea and vomiting for the groups. A fixed effects model was used because no significant heterogeneity was identified in the pooled results ( χ 2 = 0.28, df = 3, I 2 = 0.0%, P = 0.964).…”