Bone turnover and periprosthetic bone loss after cementless total hip arthroplasty can be restored by zoledronic acid: a prospective, randomized, open-label, controlled trial

Abstract

BackgroundAlthough the loss of bone mineral density (BMD) after total hip arthroplasty (THA) is a known problem, it remains unresolved. This study prospectively examined the effect of zoledronic acid (ZA) on bone turnover and BMD after cementless THA.MethodsBetween January 2010 and August 2011, 60 patients who underwent cementless THA were randomly assigned to receive either ZA infusion or placebo (0.9% normal saline only) postoperatively. ZA was administered at 2 day and 1 year postoperatively. Periprosthetic BMD in seven Gruen zones was assessed preoperatively and at given time points for 2 years. Serum markers of bone turnover, functional scales, and adverse events were recorded.ResultsEach group contained 27 patients for the final analysis. The loss of BMD across all Gruen zones (significantly in zones 1 and 7) up to 2 years postoperatively was noted in the placebo group. BMD was significantly higher in the ZA group than in the placebo group in Gruen zones 1, 2, 6, and 7 at 1 year and in Gruen zones 1, 6, and 7 at 2 years (p < 0.05). Compared with baseline measures of BMD, the ZA group had increased BMD in zones 1, 2, 4, 5, 6, and 7 at 1 year and in zones 1, 4, 6, and 7 at 2 years (p < 0.05). Serum bone-specific alkaline phosphatase and N-telopeptide of procollagen I levels were significantly increased at 6 weeks in the placebo group and decreased after 3 months in the ZA group. A transient decrease in osteocalcin level was found at 6 months in the ZA group. Functional scales and adverse events were not different between the two groups.ConclusionsThe loss of periprosthetic BMD, especially in the proximal femur (zones 1 and 7), after cementless THA could be effectively reverted using ZA. In addition, bone turnover markers were suppressed until 2 years postoperatively following ZA administration.Trial registrationChang Gung Memorial Hospital Protocol Record 98-1150A3, Prevention of Periprosthetic Bone Loss After Total Hip Replacement by Annual Bisphosphonate Therapy, has been reviewed and will be made public on ClinicalTrials.gov. Trial registration number: NCT02838121. Registered on 19 July, 2016.

Raloxifene Prevents Early Periprosthetic Bone Loss for Postmenopausal Women after Uncemented Total Hip Arthroplasty: A Randomized Placebo‐Controlled Clinical Trial

“…However, subsequently, the 5-year BMD changes were not significantly different between groups. Huang et al (2017) 28 showed that zoledronic acid (ZA), a third-generation bisphosphonate, could effectively revert the loss of periprosthetic BMD, especially in the proximal femur (zones 1 and 7), which is similar to the present results. All these studies mentioned above did not evaluate patients' QoL after THA.…”

“…Several studies have evaluated the effects of other antiosteoporosis drugs on the prevention of periprosthetic bone loss around the femoral stem, and some have found positive results [25][26][27][28] . Muren et al 25 reported that the effect of risedronate on preventing periprosthetic bone loss postoperatively failed to be seen at 4 years with a cohort of 61 patients.…”

The Efficacy of Denosumab for Prevention of Early Periprosthetic Bone Loss After Cementless Total Hip Arthroplasty

“…(3)(4)(5)(6)(7)(8)(9) A number of studies have investigated the efficacy of bisphosphonates for the preservation of periprosthetic BMD after THA, which found that periprosthetic bone loss could be effectively arrested or even reverted. (9)(10)(11) The current limited data demonstrated that denosumab is at least as effective as bisphosphonates in decreasing bone resorption, and denosumab even increases bone mass in some Gruen zones, although the exact BMD changes in each Gruen zone were not given in detail in the present study. (1,2) However, both studies found that the periprosthetic BMDs of the denosumab group approached the levels of the placebo group after discontinuation of denosumab, although the rebound effect was only observed in the present study and might have been missed in the other study.…”

Perioperative patient-specific factors-based nomograms predict short-term periprosthetic bone loss after total hip arthroplasty

“…As we mentioned before, not all the patients experienced periprosthetic bone loss after THA [7,8], while early medical intervention was recommended for all the patients underwent THA [5,6]. Numerous studies demonstrated that the administration of bisphosphonate effectively inhibited postoperative periprosthetic bone loss from one to three years after the THA [13,[26][27][28][29]. However, there is no clear guideline regarding the indication of bisphosphonate treatment for patients underwent THA, especially for those without osteoporosis and osteopenia.…”