Alendronate Reduces Periprosthetic Bone Loss After Uncemented Primary Total Hip Arthroplasty: A Prospective Randomized Study

Abstract

Periprosthetic bone loss, especially in the proximal part of the femur, is common after cemented and uncemented total hip arthroplasty (THA). Bone loss can be progressive and, in the extreme, may threaten survival of the prosthesis. To study whether alendronate therapy can reduce bone loss adjacent to prostheses, 13 uncemented primary THA patients were randomized to the study. They received 10 mg alendronate ؉ 500 mg calcium (n ‫؍‬ 8) or 500 mg calcium only (n ‫؍‬ 5) daily for 6 months follow-up after THA. Periprosthetic bone mineral density (BMD) was measured with dual energy X-ray absorptiometry (DXA). Decreases in periprosthetic BMD in the alendronate-treated group were lower compared with the changes in the calciumonly group in the same regions of interest at the same follow-up time. In the proximal femur, the mean BMD decrease was 17.1% in the calcium-only group, whereas in the alendronate-treated group the decrease was only 0.9% (p ‫؍‬ 0.019). The mean periprosthetic BMD change was also significantly different in the total periprosthetic area between the study groups at the end of the follow-up (calcium-only group ؊9.9% vs. alendronate-treated group ؊2.6%; p ‫؍‬ 0.019). Alendronate therapy led to a significant reduction in periprosthetic bone loss after primary uncemented THA compared with the changes found in patients without therapy. This kind of bone response may improve the support of the prosthesis and may result in better survival of the prosthesis. However, in this study the follow-up time was too short and the study population was too small to make any long-term conclusions as to the prognosis for THA patients treated with alendronate. (J Bone Miner Res 2001;16:2126 -2131)

The Effect of Soaking Allograft in Bisphosphonate: A Pilot Dose-response Study

“…These compounds have strong affinity to bone and can inhibit bone resorption [10]. Several clinical studies suggest the use of bisphosphonates as oral and local adjuvants in total joint arthroplasties increase periimplant bone density or reduce implant migration [19,26,27]. The effect of soaking morselized allograft in bisphosphonate before impacting it around an experimental implant has been described [6,14].…”

Implants delivering bisphosphonate locally increase periprosthetic bone density in an osteoporotic sheep model. A pilot study

“…However, when administered orally, the bioavailability of bisphosphonate is generally very low, and its local delivery can be further delayed in regions of the skeleton with low blood perfusion, for example the femoral neck. Recent clinical studies have shown that systemic bisphosphonate treatment following prosthesis implantation reduced periprosthetic bone loss only after 3 months (Nehme et al, 2003;Venesmaa et al, 2001b), while significant bone loss arises during this initial period of 3 months (Venesmaa et al, 2001a). A solution to accelerate the local availability of bisphosphonate at the implant location is to deliver the drug locally.…”

Use of medications and risk of revision after primary total hip arthroplasty

“…These are all factors that may improve implant survival , Peter et al, 2005, Eberhardt et al, 2006. Although findings are conflicting, many RCTs have reported beneficial effects of bisphosphonates on periprosthetic bone mineral density and decreased stress shielding after primary THA (Yamaguchi et al, 2003, Yamasaki et al, 2007, Venesmaa et al, 2001, Fokter et al, 2005, Arabmotlagh et al, 2006. This increase in bone mineral density may even persist years after discontinuation of bisphosphonates treatment (Arabmotlagh et al, 2006).…”

“…Although findings are conflicting, many clinical randomized trials have reported beneficial effects of short-term treatment with bisphosphonates on periprosthetic bone mineral density and deceased stress shielding after primary THA (Yamaguchi et al, 2003, Yamasaki et al, 2007, Venesmaa et al, 2001, Fokter et al, 2005, Arabmotlagh et al, 2006. Improved fixation of the implants due to bisphosphonates has therefore been suggested.…”