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Cytotoxic Effect of Zoledronic Acid-Loaded Bone Cement on Giant Cell Tumor, Multiple Myeloma, and Renal Cell Carcinoma Cell Lines
Pawel Zwolak, MD1; J. Carlos Manivel, MD2; Piotr Jasinski, MD3; Mark N. Kirstein, PhD4; Arkadiusz Z. Dudek, MD, PhD3; James Fisher, BS4; Edward Y. Cheng, MD1
1 Department of Orthopaedic Surgery, University of Minnesota Medical School and Masonic Cancer Center, 2450 Riverside Avenue, R200, Minneapolis, MN 55454. E-mail address for E.Y. Cheng: cheng002@umn.edu
2 Department of Laboratory Medicine and Pathology, University of Minnesota, MMC 76 Mayo, 8076, 420 Delaware Street S.E., Minneapolis, MN 55455
3 Division of Hematology, Oncology and Transplantation, University of Minnesota, MMC 480 Mayo, 8480, 420 Delaware Street S.E., Minneapolis, MN 55455
4 Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Lab 522, 717 Delaware Street S.E., Minneapolis, MN 55414
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the University of Minnesota Medical School and Masonic Cancer Center, Minneapolis, Minnesota

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Jan 01;92(1):162-168. doi: 10.2106/JBJS.H.01679
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Local recurrence with subsequent osteolysis is a problem after intralesional curettage of giant cell tumor of bone, myeloma, and metastatic carcinoma. The bisphosphonate zoledronic acid (zoledronate) has been shown to reduce osteoclast activity, and its local administration is a potentially attractive therapy, especially for the osteoclast-rich giant cell tumor. The aim of this study was to analyze the elution dynamics of zoledronic acid release from acrylic bone cement and its in vitro antitumor efficacy.


Various concentrations of zoledronic acid were mixed with bone cement and placed in distilled water. The concentration in the water was measured daily for fourteen days. The cytotoxic effects of the dissolved zoledronic acid on cultures of multiple myeloma, giant cell tumor, and renal cell carcinoma cells were tested with use of the MTT assay (tetrazolium [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] dye) and analyzed according to the zoledronic acid concentration and the elapsed time.


The release of zoledronic acid was greatest during the first twenty-four hours for all concentrations and decreased rapidly during the next forty-eight hours to reach a plateau after four days. The proliferation assay (MTT) showed zoledronic acid to have significant cytotoxicity in cultures of stromal giant cell tumor, multiple myeloma, and renal cell carcinoma cells. In addition, zoledronic acid decreased the number of viable tumor cells in a dose-dependent manner. Renal cell carcinoma from bone (RBM1-IT4) and stromal giant cell tumor of bone were more susceptible to zoledronic acid than was multiple myeloma.


The method presented in our study is a reproducible technique for evaluating zoledronic acid elution from bone cement and determining its impact on tumor growth. Zoledronic acid is released from bone cement, remains biologically active despite the polymerization of cement, and inhibits the in vitro growth of cell lines from giant cell tumor of bone, myeloma, and renal cell carcinoma.

Clinical Relevance: 

Local delivery of zoledronic acid by packing an osseous defect with zoledronic acid-impregnated cement after tumor curettage may have beneficial effects both through direct antineoplastic activity and by reducing osteolysis, thus improving local control without incurring systemic toxicity.

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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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