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The Use of Alendronate to Prevent Early Collapse of the Femoral Head in Patients with Nontraumatic OsteonecrosisA Randomized Clinical Study
Kuo-An Lai, MD1; Wun-Jer Shen, MD2; Chyun-Yu Yang, MD1; Chung-Jung Shao, MD1; Jui-Ting Hsu, PhD1; Ruey-Mo Lin, MD1
1 Orthopaedic Department (K.-A.L., C.-Y.Y., C.-J.S., and R.-M.L.) and the Institute of Biomedical Engineering (J.-T.H.), National Cheng Kung University Medical Center, No. 138 Shen-Li Road, Tainan, Taiwan. E-mail address for K.-A. Lai: laikuoan@mail.ncku.edu.tw. E-mail address for J.-T. Hsu: richard@ms32.url.com.tw
2 Po-Cheng Orthopaedic Institute, 100 Po-Ai 2nd Road, Kaohsiung 81357, Taiwan
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The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (MSD) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which four of the authors are affiliated or associated.
Investigation performed at the Orthopaedic Department, National Cheng Kung University Medical Center, Tainan, Taiwan

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Oct 01;87(10):2155-2159. doi: 10.2106/JBJS.D.02959
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Background: Osteonecrosis of the femoral head is the most common diagnosis leading to total hip arthroplasty in young adults. Joint-preserving treatment options have been mainly surgical, with inconsistent results. Alendronate (a bisphosphonate agent) has been shown to lower the prevalence of vertebral compression fractures and could potentially retard the collapse of an osteonecrotic femoral head. The purpose of this study was to test the effect of alendronate in preventing early collapse of the femoral head in patients with nontraumatic osteonecrosis.

Methods: Forty patients with Steinberg stage-II or III nontraumatic osteonecrosis of the femoral head and a necrotic area of >30% (class C) were randomly divided into alendronate and control groups of twenty patients each. Patients in the alendronate group took 70 mg of alendronate orally per week for twenty-five weeks, while the patients in the control group did not receive this medication or a placebo. The patients were observed for a minimum of twenty-four months. Harris hip scores, plain radiographs, and magnetic resonance imaging scans were obtained.

Results: During the study period, only two of twenty-nine femoral heads in the alendronate group collapsed, whereas nineteen of twenty-five femoral heads in the control group collapsed (p < 0.001). One hip in the alendronate group underwent total hip arthroplasty, whereas sixteen hips in the control group underwent total hip arthroplasty (p < 0.001).

Conclusions: Alendronate appeared to prevent early collapse of the femoral head in the hips with Steinberg stage-II or IIIC nontraumatic osteonecrosis. A longer duration of follow-up is needed to confirm whether alendronate prevents or only retards collapse.

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

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    Accreditation Statement
    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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