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Scientific Articles   |    
The Effect of Weekly Risedronate on Periprosthetic Bone Resorption Following Total Hip ArthroplastyA Randomized, Double-Blind, Placebo-Controlled Trial
Olof Gustaf Sköldenberg, MD, PhD1; Mats Olof Salemyr, MD1; Henrik Stefan Bodén, MD, PhD1; Torbjörn Efraim Ahl, MD, PhD1; Per Yngve Adolphson, MD, PhD1
1 Division of Orthopaedics, Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Danderyds Sjukhus, 18288 Stockholm, Sweden. E-mail address for O.G. Sköldenberg: olof.skoldenberg@ds.se. E-mail address for M.O. Salemyr: mats.salemyr@ds.se. E-mail address for H.S. Bodén: henrik.boden@ds.se. E-mail address for T.E. Ahl: torbjorn.ahl@ds.se. E-mail address for P.Y. Adolphson: pellesoft@bredband.net
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Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Investigation performed at the Division of Orthopaedics, Department of Clinical Sciences at Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
A commentary by William G. Hamilton, MD, is linked to the online version of this article at jbjs.org.

Copyright © 2011 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2011 Oct 19;93(20):1857-1864. doi: 10.2106/JBJS.J.01646
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Abstract

Background: 

Bone loss leading to late-occurring periprosthetic femoral fracture is a mode of failure in cementless total hip arthroplasty. The aim of this trial was to investigate the effect of a bisphosphonate, risedronate, on femoral periprosthetic bone resorption following total hip arthroplasty in patients with osteoarthritis of the hip.

Methods: 

We enrolled seventy-three patients between the ages of forty and seventy years who were scheduled to undergo total hip arthroplasty in a single-center, randomized, double-blind, placebo-controlled trial. Subjects were randomly assigned to receive either 35 mg of risedronate (n = 36) or a placebo (n = 37) orally once weekly for six months. The primary end point was the change in bone mineral density in Gruen femoral zones 1 and 7. Bone mineral density scans were made preoperatively and at two days and three, six, twelve, and twenty-four months postoperatively. Secondary end points included migration of the femoral stem and clinical outcome.

Results: 

Seventy of the seventy-three patients (thirty-three in the risedronate group and thirty-seven in the placebo group) were analyzed for the primary end point. The mean bone mineral density in zone 1 was 9.2% higher (95% confidence interval [CI], 4.2% to 14.1%) in the risedronate group than in the placebo group at six months postoperatively and 7.2% higher (95% CI, 1.0% to 13.3%) at one year. The mean bone mineral density in zone 7 was 8.0% higher (95% CI, 2.7% to 13.4%) in the risedronate group than in the placebo group at six months postoperatively and 4.3% higher (95% CI, –1.5% to 10.1%) at one year. Migration of the femoral stem, the clinical outcome, and the frequency of adverse events did not differ between the groups.

Conclusions: 

Risedronate taken once weekly for six months following total hip arthroplasty was effective in reducing periprosthetic bone resorption around an uncemented femoral stem up to one year after surgery but had no discernible effect on implant migration or clinical outcome. Future studies of bisphosphonate treatment following total hip arthroplasty should focus on clinically relevant end points such as the risks of fracture and revision arthroplasty.

Level of Evidence: 

Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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