Biological options to enhance periprosthetic bone mass

There is a potential for the use of pharmacological agents to enhance the quality of bone around a total hip or knee prosthesis, reducing the risk of implant failure or periprosthetic fracture. Bisphosphonates are currently used for the management of postmenopausal osteoporosis and recent investigations also suggest a potential role for the management of postoperative periprosthetic bone loss. Current evidence suggests that the short-term gains may not be sustained in the long term. Teriparatide and parathyroid hormone 1-84 have been licensed to treat postmenopausal osteoporosis and may also be investigated for the potential to enhance periprosthetic bone mass. In addition, other agents such as calcitonin and strontium ranelate, non-anabolic agents such as doxycycline, and recombinant OPG adeno-associated virus (rAAV) gene therapy, may in the future provide solutions for enhancing periprosthetic bone mass.