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Decreased periprosthetic bone loss in patients treated with clodronate: a 1-year randomized controlled study
C Trevisan1, S Ortolani, P Romano
1Department of Orthopedics, University of Milano-Bicocca, Milan, Italy.
Insights
Intramuscular clodronate significantly reduced bone loss around uncemented total hip arthroplasty (THA) stems over 12 months. The treatment was more effective in women, suggesting targeted prevention for high-risk individuals.
Area of Science:
- Orthopedics
- Pharmacology
- Bone Metabolism
Background:
- Total hip arthroplasty (THA) with uncemented stems can lead to periprosthetic bone loss.
- Bisphosphonates are investigated for their potential to mitigate bone loss post-THA.
Purpose of the Study:
- To evaluate the efficacy of intramuscular clodronate in reducing bone loss around uncemented THA stems.
- To assess gender-specific differences in bone loss and clodronate treatment response.
Main Methods:
- A randomized controlled trial involving 91 patients undergoing uncemented THA.
- Patients received weekly intramuscular clodronate (100 mg) for 12 months or no treatment.
- Bone mineral density (BMD) and biochemical markers of bone turnover were measured at baseline and follow-up points.
Main Results:
- Clodronate treatment significantly reduced bone loss in most Gruen zones, particularly zones 2 and 6 (6.6% and 5.9% difference, respectively) at 12 months.
- Women showed significantly less bone loss with clodronate treatment compared to untreated women (6.2-13.3% difference in five zones).
- No significant BMD differences were observed between treated and untreated men.
Conclusions:
- One-year intramuscular clodronate treatment effectively reduces bone loss following THA.
- The efficacy is more pronounced in women, who are at higher risk for bone loss.
- Identifying high-risk patients is crucial for implementing preventive strategies.
Abstract:
The efficacy of clodronate to reduce bone loss around uncemented stems after total hip arthroplasty(THA) was evaluated. Ninety-one patients operated with uncemented THA were randomized to receive either intramuscular clodronate at a dose of 100 mg weekly for 12 months or no treatment. Periprosthetic and contralateral bone mineral density (BMD) scans were performed and biochemical markers of bone turnover measured at baseline and at 3, 6, and 12 months. At month 12, with the exception of Gruen zones 4 and 5, patients treated with clodronate showed less bone loss at all zones, reaching statistical significance (P\0.05) in Gruen zones 2 and 6 (difference of 6.6 and 5.9%, respectively). Analysis of data according to gender revealed sex-related differences in bone loss and efficacy of treatment. After 12 months, the difference in bone loss between treated and untreated women in five out of seven Gruen zones ranged from 6.2 to 13.3% (SS at zones 2 and 6), whereas comparison between treated and untreated men showed no BMD differences in all zones(P[0.05). Median percent changes in serum levels of markers of bone metabolism by gender were consistent with BMD changes. A 1-year treatment with intramuscular clodronate determined a significant reduction of bone loss after THA. This was mainly attributed to its greater efficacy in the female population, which is at higher risk for bone loss. This observation suggests the need for the characterization of high-risk subjects as potential candidates for prevention strategies.
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