Bisphosphonate therapy for the prevention of osteolysis in total joint replacements

Abstract

Aseptic loosening is the number one impediment to extending the useful life span of total joint replacements. The etiologic agent is believed to be submicron ultrahigh molecular weight polyethylene debris from the acetabular liner, which stimulates a macrophage-mediated inflammatory response. Therapeutic approaches using bisphosphonates represent a convenient and effective manner to target the end effector cell, which is the osteoclast. The studies reviewed here highlight the encouraging prospects of using bisphosphonates to prevent and potentially treat periprosthetic bone loss associated with osteolysis. There appear to be minimal complications, and the mechanisms of action are fairly well understood. Thus, bisphosphonates are appropriate candidates in a growing repertoire of materials development, implant design, and pharmaceutical agents to combat periprosthetic osteolysis.