Effect of one-year post-operative alendronate treatment on periprosthetic bone after total knee arthroplasty

Abstract

Total knee arthroplasty (TKA) is known to lead to a reduction in periprosthetic bone mineral density (BMD). In theory, this may lead to migration, instability and aseptic loosening of the prosthetic components. Bisphosphonates inhibit bone resorption and may reduce this loss in BMD. We hypothesised that treatment with bisphosphonates and calcium would lead to improved BMD and clinical outcomes compared with treatment with calcium supplementation alone following TKA. A total of 26 patients, (nine male and 17 female, mean age 67 years) were prospectively randomised into two study groups: alendronate and calcium (bisphosphonate group, n = 14) or calcium only (control group, n = 12). Dual energy X-ray absorptiometry (DEXA) measurements were performed post-operatively, and at three months, six months, one, two, four, and seven years post-operatively. Mean femoral metaphyseal BMD was significantly higher in the bisphosphonate group compared with controls, up to four years following surgery in some areas of the femur (p = 0.045). BMD was observed to increase in the lateral tibial metaphysis in the bisphosphonate group until seven years (p = 0.002), and was significantly higher than that observed in the control group throughout (p = 0.024). There were no significant differences between the groups in the central femoral metaphyseal, tibial medial metaphyseal or diaphyseal regions of interest (ROI) of either the femur or tibia. Bisphosphonate treatment after TKA may be of benefit for patients with poor bone quality. However, further studies with a larger number of patients are necessary to assess whether this is clinically beneficial.

The action of anti-resorptive drugs on the survival of total knee and hip arthroplasty

“…From the measurements made on DXA, immediately postoperatively, at three and six months, at the first, second, third, fourth and seventh year the authors report increase BMD in the outer part of the tibia metaphysis in the study group in seven years (p=0.002) and a substantially higher rate of BMD throughout all measurements compared to the control group (p=0.024). There were no significant differences in other parts 24 .…”

Effect of bisphosphonates on periprosthetic bone loss after total knee arthroplasty: a meta-analysis of randomized controlled trials

“…No serious adverse effect was reported related to BPs in the 5 trials. The mostly reported adverse effect was digestive discomfort in 3 trials: 1 of 8 by Soininvaara [ 16 ]; 5 patients by Wang [ 18 ]; 2 patients by Jaroma [ 20 ]. There was no severe side effect on renal, hepatic, or heart function.…”

“…If information was not described as text in the publications, we extracted it from the figures, tables, or other supplementary material. The characteristics of five finally included RCTs [ 16 – 20 ] were showed in Table 1 . The primary outcome measurement was total periprosthetic BMD of knee.…”

“…BPs are inhibitors of bone resorption which promote bone mineralization and inhibit farnesyl pyrophosphate synthase [ 12 , 13 ]. Some studies revealed that bisphosphonates can decrease fracture risk and prolong survival time of implant [ 14 , 15 ], and some randomized controlled trials have investigated the effect of reduce periprosthetic bone loss after total knee arthroplasty [ 16 – 20 ]. To confirm the effect of BPs on periprosthetic bone loss after total joint arthroplasty, we have made a previous meta-analysis [ 21 ], of which included 14 RCTs in 2012, and the result revealed that BPs could prevent bone loss after arthroplasty in medium-term follow-up.…”

A Novel Peptide, CK2.3, Improved Bone Formation in Ovariectomized Sprague Dawley Rats

“…Due to the age of the rats, we determined that using tibiae for this study would not be appropriate. Additionally, the effect of osteoporosis treatments on improving BMD has shown to be similar in femur and tibia [ 58 , 59 , 60 , 61 ]…”