title: Efficacy of alendronate for preventing collapse of femoral head in adult patients with nontraumatic osteonecrosis.
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.
authors.affiliation: Department of Emergency, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3 East Qingchun Road, Hangzhou 310008, China.
authors.forename: Yu-Cai
authors.initials: YC
authors.lastname: Hong
authors.affiliation: Department of Emergency, Research Institute of Emergency Medicine, Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Road, Hangzhou 310009, China.
authors.forename: Ru-Bin
authors.initials: RB
authors.lastname: Luo
authors.affiliation: Department of Orthopaedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Road, Hangzhou 310009, China.
authors.forename: Tiao
authors.identifier: 0000-0002-7703-612X
authors.initials: T
authors.lastname: Lin
authors.affiliation: Department of Emergency, Research Institute of Emergency Medicine, Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Road, Hangzhou 310009, China.
authors.forename: Hui-Ming
authors.initials: HM
authors.lastname: Zhong
authors.affiliation: Department of Emergency, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3 East Qingchun Road, Hangzhou 310008, China.
authors.forename: Jian-Bin
authors.initials: JB
authors.lastname: Shi
mesh_terms: D019386:Alendronate / Q000627:therapeutic use*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D005270:Femur Head / Q000187:drug effects / Q000293:injuries* / Q000503:physiopathology; D006801:Humans; D008096:Lithotripsy; D010020:Osteonecrosis / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D019386:Alendronate