Effect of Alendronate on Periprosthetic Bone Loss After Total Knee Arthroplasty: A One-Year, Randomized, Controlled Trial of 19 Patients

Abstract

Undesired bone loss around implants is considered to occur mainly because of a stress-shielding phenomenon. Bone surrounding the total knee arthroplasty (TKA) adjusts its mineral density and structure to meet new mechanical demands. Immobilization, in combination with local operative trauma to the bone and soft tissues, has an additional impact on bone loss. The clinical survival of TKA is associated with the quality and quantity of the surrounding bone environment. Poor bone quality and quantity may predispose to aseptic implant loosening and periprosthetic fractures. We investigated the efficacy of oral bisphosphonate (alendronate, Fosamax) with calcium (Calcichew) for the inhibition of early bone mineral density (BMD) loss after TKA in a prospective, randomized, one-year follow-up study. Periprosthetic BMD changes were measured with fan-beam dual-energy X-ray absorptiometry (DXA) in 19 patients with knee osteoarthrosis. Patients (n = 8) treated with 10 mg alendronate and 500 mg calcium daily maintained distal femoral BMD values close to the baseline values (P > 0.04), while patients receiving only 500 mg of calcium daily (n = 11) showed significant bone loss during the one-year follow-up (P < 0.015). The treatment groups differed significantly in metaphyseal anterior, posterior, diaphyseal, and metaphyseal total regions of interest (ROIs) (repeated measures ANOVA analyses, P = 0.019, P = 0.010, P = 0.022, and P = 0.024, respectively). Our results indicate that oral alendronate reduces early postoperative periprosthetic bone loss significantly. This therapeutic strategy may improve the results and longevity of primary total knee arthroplasties.

Bisphosphonates for periprosthetic bone loss after joint arthroplasty: a meta-analysis of 14 randomized controlled trials

“…Oral alendronate was used in nine trials [11,13,14,19,[29][30][31][32][33], oral etidronate in two trials [9,15], oral risedronate in one trial [34], intravenous pamidronate in one trial [12], and intramuscular clodronate in one trial [10]. The dose and the duration of BP administration differed among the trials.…”

Local alendronate increases fixation of implants inserted with bone compaction: 12‐week canine study

“…Several studies have investigated the use of bisphosphonates as adjuvant in implant fixation. [5][6][7][8][9][10] The general findings were increased peri-implant bone density or reduced implant migration.…”

PTH improves titanium implant fixation more than pamidronate or renutrition in osteopenic rats chronically fed a low protein diet

“…Both bisphosphonates and parathyroid hormone (PTH) treatment have been reported to improve implant fixation, allowing for more durable joint replacements [22][23][24][25][26][27][28][29][30][31][32]. Indeed, in a recent study, we showed that both PTH and pamidronate were able to prevent the deleterious effects of an isocaloric protein restricted diet on bone microarchitecture close to the implant and on mechanical fixation in adult female rats [33].…”