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.
Highlights
The loss of bone mineral density (BMD) after total hip arthroplasty (THA) is a known problem, it remains unresolved
Cementless total hip arthroplasty (THA) has become popular in recent decades [1, 2], but its long-term stability may be limited by progressive bone loss around the prosthetic implant [3, 4]
The BMD changes from baseline (BMD ratio) were significantly higher for the zoledronic acid (ZA) group in Gruen zones 2, 4, 6, and 7 at 12 weeks; in zones 1, 6, and 7 at 6 months; in zones 1, 2, 4, 5, 6 and 7 at 1 year, and in zones 1, 4, 6, and 7 at 2 years (Table 3)
Summary
The loss of bone mineral density (BMD) after total hip arthroplasty (THA) is a known problem, it remains unresolved. Cementless total hip arthroplasty (THA) has become popular in recent decades [1, 2], but its long-term stability may be limited by progressive bone loss around the prosthetic implant [3, 4]. Bisphosphonates are anti-resorptive agents that promote bone mineralization and inhibit farnesyl pyrophosphate synthase [12]. Their protective effects after joint arthroplasty have been shown in recent meta-analysis studies [13,14,15] wherein the periprosthetic BMD continued to increase by 9.40% at 18–70 months after discontinuation of bisphosphonate therapy
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