Studies of the mechanisms of periprosthetic bone loss have led to the development of pharmacologic strategies intended to enhance bone mass recovery after surgery and consequently prevent aseptic loosening and prolong the implant survival.
Bisphosphonates, potent anti-resorptive drugs widely used in the treatment of
osteoporosis and other disorders of bone metabolism, were shown to be particularly effective in reducing periprosthetic
bone resorption in the first year after hip and
knee arthroplasty, both cemented and cementless. Based on these results, we investigated the inhibitory effects of
ibandronate on periprosthetic bone loss in a 2-year study of postmenopausal women that underwent cementless
total hip arthroplasty. In the first 6 months both groups (A, treated with
ibandronate 3 mg i.v. within five days after surgery and then with oral
ibandronate 150 mg/month, plus
calcium and
vitamin D supplementation; and B, treated with
calcium and
vitamin D supplementation only) experienced bone loss, though to a lesser extent in group A. After 12 months, group A showed a remarkable BMD recovery, that was statistically significant versus baseline values (about +1, 74% of global BMD) and most evident in region R1 (+3, 81%) and R2 (+4, 12%); in group B, on the contrary, BMD values were unchanged compared with those at 6 months post-surgery. Quality of life scores also showed a greater improvement in group A, both at 6 and 12 months after surgery, likely because of the
pain-reducing effects of
ibandronate treatment.