Bisphosphonate in the prevention of collapse of the femoral head in non-traumatic osteonecrosis

Abstract

Osteonecrosis (ON) is one of the major debilitating skeletal disorders. Most patients with ON of the femoral head eventually need surgery, usually total hip arthroplasty (THA), within a few years of onset. Previous reports showed that alendronate has a pharmacological effect in reducing osteoclastic activity and that it significantly reduced the incidence of collapse of the femoral head in the osteonecrotic hip in case control study. Further prospective, multicenter, randomized, trials with double-blind or open label were conducted by treatment with alendronate or zolendronate. In this review, we mainly focus on the prospective, multicenter, randomized, trials to evaluate the effect of bisphosphonates in the treatment of ON. With the current evidence, the effect of bisphosphonate on osteonecrosis of the femoral head remains controversial. Due to the possible side effects, careful selection of patients is advised and prolonged administration of bisphosphonate should be avoided, especially in young patients. Further studies may be necessary to clarify its clinical effects and optimal period of application.