Effects of discontinuation as well as intervention of cyclic therapy with etidronate on bone remodeling after cementless total hip arthroplasty

Abstract

We previously reported the effects of cyclic therapy with etidronate (CTE) on periprosthetic bone mineral density (BMD) after cementless total hip arthroplasty (THA). This study aimed to evaluate the effects of withdrawal and intervention of CTE after cementless THA. The control group consisted of 24 patients without osteoactive drugs. Sixteen patients continued on CTE (i.e., 400 mg/day oral etidronate for 2 weeks followed by 12 weeks of 500 mg/day calcium lactate, repeated every 14 weeks) for the first 12 months followed by no treatment for 18 months (early-etidronate group). Fifteen patients received no treatment for the first 18 months followed by CTE for 12 months (late-etidronate group). Periprosthetic BMD in seven regions of interest based on the zones of Gruen et al. was measured with dual energy X-ray absorptiometry at 3 weeks, 6, 12, 18, 24, and 30 months postoperatively. At 12 months after operation (off therapy point in the early-etidronate group), postoperative decreases of BMD in the early-etidronate group were significantly smaller than those in the control group in zones 1, 2, 5, 6, and 7 and those in the late-etidronate group in zones 1, 5, 6, and 7 ( P < 0.05 for each). In the early-etidronate group, significant decreases in BMD were found during months 12–30 (off therapy period) after withdrawal of CTE in zones 1 and 7 ( P < 0.05 for each). In the late-etidronate group, BMD increased significantly in zones 4 and 6 ( P < 0.05 for each) during months 18–30 (on therapy period) after intervention trial, while in the controls, BMD decreased significantly in zone 3 ( P < 0.05) over this period. At the final follow-up (30 months), BMD loss in zone 7 was significantly less in the early-etidronate group than in the other groups ( P < 0.05). BMD changes in the early-etidronate group and late-etidronate group were associated with changes in biochemical bone markers.