Dosisabhängige Prophylaxe des frühen periprothetischen Knochenschwundes durch Alendronat

Zusammenfassung

Studienziel: Ein periprothetischer Knochenschwund tritt in den ersten 6 Monaten nach Hüfttotalendoprothetik (TEP) auf und ist weitgehend auf die Folgen des operativen Traumas, die postoperative Minderbelastung und die veränderte Krafteinleitung durch die Prothese zurückzuführen. Ziel dieser prospektiven, randomisierten, offenen und endpunktverblindeten Studie ist die Prophylaxe des frühen periprothetischen Knochenschwundes um den Schaft durch eine orale Bisphosphonattherapie. Methode: 66 gesunde Patienten mit unzementierter TEP und unterdurchschnittlicher lumbaler Knochendichte (BMD) (negativer T-score) wurden postoperativ mit Alendronat behandelt: n = 21 erhielten 10 Wochen 10 mg/d (A), n = 21 5 Wochen 20 mg/d (B), n = 24 ohne Therapie als Kontrollgruppe (KG). Die periprothetische BMD wurde mittels DEXA nach dem 2., 4., 6. und 12. Monat in den Regionen n. Gruen (ROI) bestimmt und prozentual auf den postoperativen Ausgangswert bezogen. Ergebnisse: In KG fand sich ein signifikanter Knochenverlust in allen ROI während der ersten Monate und in ROI 7 zeigte sich ein Defizit von 29 % nach einem Jahr. In B wurde der Knochenschwund komplett bis zum 2 Monat verhindert, in ROI 7 fand sich noch nach einem Jahr ein signifikanter Unterschied zu KG. In A erfolgte in allen ROI über 12 Monate ein signifikant geringerer Knochenschwund als in KG. Schlussfolgerung: Mit Alendronat ist eine Prophylaxe des frühen periprothetischen Knochenschwundes möglich. Die Therapie sollte sich über mindestens 10 Wochen erstrecken und mit einer Dosierung von 20 mg/d beginnen.

Abstract

Aim: Periprosthetic bone loss occurs in the first six months after total hip arthroplasty (THA) and is felt to be largely the result of initial operative irritation, immobilization, and stress shielding. This study (a prospective, randomized, open, blinded endpoint evaluation) aims at preventing bone loss around the stem with an oral bisphosphonate. Method: 66 healthy subjects with uncemented THA and low lumbar bone mass density (BMD) (negative T score) were treated post-operatively with alendronate as follows: n = 21 with 10 mg/d for 10 weeks (A), n = 21 20 mg/d for 5 weeks (B), n = 24 no treatment for controls (C). The periprosthetic BMD in the Gruen zones (ROI) was measured after the 2nd, 4th, 6th, and 12th month by DEXA as a percentage of the value measured one week after surgery. Results: In C, there was significant bone loss in all ROI during the first months and a deficit of 29 % in ROI 7 following one year. In B, bone loss was completely prevented up to the second month, in ROI 7, a significant difference in comparison to C was registered for the entire year. In A, significant bone loss reduction during 12 months was seen. Conclusion: Alendronate, therefore, is capable of preventing initial periprosthetic bone loss. A dosage of 20 mg/d is required initially with daily treatment lasting at least 10 weeks.

Schlüsselwörter

Endoprothetik - Bisphosphonat - Alendronat - Knochendichte - DEXA

Key words

Arthroplasty - Hip - Densitometry - Alendronate - Bisphosphonate

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