Efficacy of alendronate for preventing collapse of femoral head in adult patients with nontraumatic osteonecrosis.

Yu-Cai Hong,Hui-Ming Zhong,Ru-Bin Luo,Jian-Bin Shi,Tiao Lin

doi:10.1155/2014/716538

Abstract

The purpose of the current review was to determine the efficacy of alendronate for preventing collapse of femoral head in adult patients with nontraumatic avascular osteonecrosis of femoral head (ANFH). Five randomized controlled trials (RCTs) involving 305 hips were included in this review, of which 3 studies investigated alendronate versus control/placebo and the other 2 studies compared the combination of alendronate and extracorporeal shockwave therapy (ESWT) with ESWT alone. Our results suggested that even the patients with extensive necrosis encountered much less collapse in the alendronate group than control group. In these RCTs, their data also indicated a positive short- and middle-term efficacy of alendronate treatment in joint function improvement and hip pain diminishment. With the presence of the outlier study, only insignificant overall efficacy of alendronate could be observed with substantial heterogeneities. In addition, we did not find any additive benefits of alendronate in combination with ESWT for preventing collapse compared to ESWT alone. In conclusion, there is still lack of strong evidence for supporting application of alendronate in adult patients with nontraumatic ANFH, which justified that large scale, randomized, and double-blind studies should be developed to demonstrate the confirmed efficacies, detailed indication, and optimized strategy of alendronate treatment.

Highlights

Osteonecrosis or avascular necrosis of femoral head (ANFH) is a disabling clinical disease that affects 20,000 persons each year in the United States
All studies were undertaken in Asia published in the recent 10 years with follow-up of 12–48 months, of which, 3 studies investigated alendronate alone versus control/placebo [13,14,15] and the other 2 studies compared the combination of alendronate and extracorporeal shockwave therapy (ESWT) versus ESWT alone [31, 32]
The studied patients were all within stage III based on X-ray and/or Magnetic resonance imaging (MRI) according to Steinberg (University of Pennsylvania staging system, 2 studies) [13, 14] or Association Research Circulation Osseous (ARCO staging system, 3 studies) [15, 31, 32]

Summary

Introduction

Osteonecrosis or avascular necrosis of femoral head (ANFH) is a disabling clinical disease that affects 20,000 persons each year in the United States. The progressive disease is characterized by reduced local blood flow and death of the osteocytes and the bone marrow [1]. After collapse of femoral head, a standard total hip arthroplasty (THA) is indicated [2, 3]. Prior invasive treatments or periprosthetic infection, aseptic prosthesis loosening after THA commonly are attributed to the increased possibilities and difficulties in the following revision surgery. When feasible, attempts should be made to save the femoral head prior to collapse with use of less invasive treatment modalities [4,5,6]

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