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Alendronate of no benefit in avascular bone necrosis



DOI:10.1038/bonekey.2012.154

Some studies have suggested that administration of bisphosphonates such as alendronatemay halt the progression of avascular bone necrosis (AVN), including collapse of the hip, when administered early in the course of the disease. This 2-year prospective randomized controlled trial (RCT) followed a total of 65 hips in 52 AVN patients, some of whom were treated with alendronate while others received placebo.

In the group treated with alendronate (32 hips), four hips required a total hip arthroplasty (THA) due to osteonecrosis of the femoral head, while in the control group (33 hips), THA was necessary in five hips. There were no differences between the groups in terms of disease progression or quality of life. The authors draw attention to the lack of power in the study, which was decreased due to the smaller than expected number of patients in both groups who required surgery.

Editor's comment: Unfortunately this RCT does not confirm the benefit of alendronate on the clinical or radiological progression in this condition. The results of this study, however, are peculiar, as progression towards collapse occurred only in a minority of the placebo group, an unusually favorable course of AVN. Whether this could be explained by a selection bias, the ethnicity of the study population (Taiwanese) and/or other unaccounted factors remains unclear. Larger, properly powered RCTs to test the effects of bisphosphonates in hip osteonecrosis remain to be performed.


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