Efficacy of Alendronate for the Prevention of Bone Loss in Calcar Region Following Total Hip Arthroplasty.
Bone mineral density (BMD) loss around femoral implants, particularly in the proximal femur, is a common outcome after total hip arthroplasty. Previous studies reported the prevention of postsurgical decrease in BMD with the use of osteoporosis drug therapy. This randomized study evaluated the efficacy of alendronate and alfacalcidol for preserving BMD over a long-term follow-up.



Sixty consecutive patients with hip osteoarthritis who had undergone primary cementless total hip arthroplasty were randomly assigned to an alendronate (n = 20), alfacalcidol (n = 18), or control (n = 22) group. Periprosthetic BMD was measured using dual-energy X-ray absorptiometry at 1 week, 1 year, and the current follow-up (minimum 9 years after surgery). Changes in BMD are reported as mean percentages relative to the values at 1 week (baseline reference).



All groups showed a significant decrease in the BMD of the calcar at the current follow-up compared to the values at both 1 week and 1 year postoperatively (P < .001). The BMD values were significantly higher in the alendronate group than in the alfacalcidol and control groups (P < .05). The BMD values at the current follow-up were 76% ± 30% (alendronate group), 64% ± 22% (alfacalcidol group), and 59% ± 22% (control group) of the baseline values.



Our findings demonstrate the efficacy of early administration of alendronate for the prevention of bone loss in the calcar region.
Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan.
Yohei
Y
Yukizawa
Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan.
Yutaka
Y
Inaba
Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan.
Naomi
N
Kobayashi
Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan.
Hyonmin
H
Choe
Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan.
So
S
Kubota
Department of Orthopaedic Surgery, Yokohama City University, Yokohama, Japan.
Tomoyuki
T
Saito
D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001862:Bone Resorption / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005269:Femur / Q000601:surgery; D006801:Humans; D006887:Hydroxycholecalciferols / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery
D050071:Bone Density Conservation Agents; D006887:Hydroxycholecalciferols; C008088:alfacalcidol; D019386:Alendronate
alendronate; alfacalcidol; bone mineral density; stress shielding; total hip arthroplasty