title: Alendronate does not inhibit early bone apposition to hydroxyapatite-coated total joint implants: a preliminary study.
abstract: BACKGROUND
  Alendronate is a pyrophosphate analogue of bisphosphonate that has been shown to inhibit osteoclastic bone resorption. Bone formation and remodeling are necessary to establish initial fixation of uncemented implants, especially those coated with a bioactive surface such as hydroxyapatite. Because the process of bone-remodeling that culminates in new-bone formation is thought to be initiated by osteoclastic bone resorption, it is appropriate to test the influence of osteoclast-inhibiting medications on bone apposition to hydroxyapatite-coated implants.
  
  
  METHODS
  Twelve dogs underwent staged bilateral total hip arthroplasty, with twenty weeks between the first and second operations, with use of a titanium-alloy femoral stem that had a proximal macrotextured surface and a plasma-sprayed hydroxyapatite coating. Six of the dogs received oral alendronate therapy from the time of the surgery until they were killed; the other six dogs were untreated controls. The animals were killed four weeks after the second operation. Sections from matched implant sites (proximal, middle, and distal) were histologically analyzed. The linear extent of bone apposition, the linear extent and the thickness of the hydroxyapatite coating, and the total amount of cortical and trabecular bone were measured with the use of an interactive image analysis system.
  
  
  RESULTS
  There were no significant differences in radiographic or histologic findings between the two groups at either four or twenty-four weeks. Although the extent of the hydroxyapatite coating decreased significantly with time in both groups (p < 0.01), we identified no significant influence of alendronate on the extent of bone apposition, the extent or thickness of the hydroxyapatite coating, or the cortical or trabecular bone area around the implants.
  
  
  CONCLUSIONS
  Many patients who are receiving alendronate for osteoporosis or other disorders may also be candidates for cementless total joint arthroplasty. Although bone formation is generally thought to be initiated by and coupled with bone resorption, our results suggest that alendronate has no discernible effect on the initial fixation of or the short-term bone-remodeling around hydroxyapatite-coated femoral total joint implants.
authors.affiliation: Department of Anatomic Pathology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Mochida
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Bauer
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Akisue
authors.forename: Phillip R
authors.initials: PR
authors.lastname: Brown
mesh_terms: D019386:Alendronate / Q000008:administration & dosage / Q000494:pharmacology*; D000818:Animals; D019644:Arthroplasty, Replacement, Hip; D016723:Bone Remodeling / Q000187:drug effects*; D001862:Bone Resorption / Q000517:prevention & control*; D004285:Dogs; D017886:Durapatite; D005500:Follow-Up Studies; D010010:Osteoclasts / Q000187:drug effects; D011182:Postoperative Care
chemical_list: D017886:Durapatite; D019386:Alendronate