Bone turnover and periprosthetic bone loss after cementless total hip arthroplasty can be restored by zoledronic acid: a prospective, randomized, open-label, controlled trial

• Published in: BMC musculoskeletal disorders Vol. 18; no. 1; p. 209
• Main Authors: Huang, Tsan-Wen, Wang, Chao-Jan, Shih, Hsin-Nung, Chang, Yuhan, Huang, Kuo-Chin, Peng, Kuo-Ti, Lee, Mel S
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 22.05.2017; BioMed Central; BMC
• Subjects: Adult; Aged; Aged, 80 and over; Analysis; Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Hip - trends; Bisphosphonate; Bone Density Conservation Agents - administration & dosage; Bone mineral density; Bone Remodeling - drug effects; Bone Remodeling - physiology; Bone turnover markers; Bones; Cementless total hip arthroplasty; Density; Diphosphonates - administration & dosage; Dosage and administration; Female; Follow-Up Studies; Humans; Imidazoles - administration & dosage; Male; Middle Aged; Osteoporosis - diagnostic imaging; Osteoporosis - drug therapy; Osteoporosis - etiology; Prospective Studies; Stress shielding; Treatment outcome; Zoledronic acid; Zoledronic acid; Stress shielding; Bisphosphonate; Bone mineral density; Cementless total hip arthroplasty; Bone turnover markers
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-017-1577-2

Although the loss of bone mineral density (BMD) after total hip arthroplasty (THA) is a known problem, it remains unresolved. This study prospectively examined the effect of zoledronic acid (ZA) on bone turnover and BMD after cementless THA. Between January 2010 and August 2011, 60 patients who underwent cementless THA were randomly assigned to receive either ZA infusion or placebo (0.9% normal saline only) postoperatively. ZA was administered at 2 day and 1 year postoperatively. Periprosthetic BMD in seven Gruen zones was assessed preoperatively and at given time points for 2 years. Serum markers of bone turnover, functional scales, and adverse events were recorded. Each group contained 27 patients for the final analysis. The loss of BMD across all Gruen zones (significantly in zones 1 and 7) up to 2 years postoperatively was noted in the placebo group. BMD was significantly higher in the ZA group than in the placebo group in Gruen zones 1, 2, 6, and 7 at 1 year and in Gruen zones 1, 6, and 7 at 2 years (p < 0.05). Compared with baseline measures of BMD, the ZA group had increased BMD in zones 1, 2, 4, 5, 6, and 7 at 1 year and in zones 1, 4, 6, and 7 at 2 years (p < 0.05). Serum bone-specific alkaline phosphatase and N-telopeptide of procollagen I levels were significantly increased at 6 weeks in the placebo group and decreased after 3 months in the ZA group. A transient decrease in osteocalcin level was found at 6 months in the ZA group. Functional scales and adverse events were not different between the two groups. The loss of periprosthetic BMD, especially in the proximal femur (zones 1 and 7), after cementless THA could be effectively reverted using ZA. In addition, bone turnover markers were suppressed until 2 years postoperatively following ZA administration. Chang Gung Memorial Hospital Protocol Record 98-1150A3, Prevention of Periprosthetic Bone Loss After Total Hip Replacement by Annual Bisphosphonate Therapy, has been reviewed and will be made public on ClinicalTrials.gov. NCT02838121 . Registered on 19 July, 2016.