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Evidence for using alendronate to treat adult avascular necrosis of the femoral head: a systematic review.

Luo RB, Lin T, Zhong HM, Yan SG, Wang JA - Med. Sci. Monit. (2014)

Bottom Line: The favorable long-term results were also presented in those treated patients after 10-year follow-up.In addition, there were no severe adverse effects associated with alendronate treatment observed during short- and long-term follow-up, and most of the included studies suggested use of alendronate in early AVN with small necrotic lesion to achieve better outcomes.Level of evidence: Level 3a.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, Research Institute of Emergency Medicine, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China (mainland).

ABSTRACT
Osteonecrosis or avascular osteonecrosis (AVN) of the femoral head is a devastating multifactorial disease that affects 20 000 persons each year in the United States. The purpose of this systematic review was to determine the efficacy and safety of alendronate for adult AVN during short- and long-term follow-up. Electronic databases were searched for randomized or nonrandomized clinical trials, cohort, case-control studies, and series of cases in which alendronate was used for treatment of adult AVN of the femoral head. Relevant articles with adequate data on reduction of pain, improvement of articular function, slowing of bone collapse progression, or need for total hip arthroplasty (THA) were included after applying inclusion and exclusion criteria. Eight articles involving 788 hips with evidence level 1b to 3b were included in this systematic review. Most studies suggested a positive short-term efficacy of alendronate treatment in reducing pain, improving articular function, slowing of bone collapse progression, and delaying the need for THA for adult AVN patients. The favorable long-term results were also presented in those treated patients after 10-year follow-up. In addition, there were no severe adverse effects associated with alendronate treatment observed during short- and long-term follow-up, and most of the included studies suggested use of alendronate in early AVN with small necrotic lesion to achieve better outcomes. The findings support consideration of alendronate use for adult AVN, particularly with early stage and small necrotic size. The lack of large-scale, randomized, and double-blind studies justifies new studies to demonstrate the detailed indication and the optimized strategy of alendronate treatment. Level of evidence: Level 3a.

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A flow diagram demonstrates the method of article selection for clinical study inclusion.
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f1-medscimonit-20-2439: A flow diagram demonstrates the method of article selection for clinical study inclusion.

Mentions: Figure 1 details study identification, inclusion, and exclusion. Our search strategy initially yielded 85 citations. Of these, we included 8 articles with 788 hips in this systematic review [12–19]. Tables 1 and 2 show the characteristics of the included articles. All the studies were conducted in Asia and published after 2000. All the studies targeted adult AVN patients within stage III classified by X-ray, magnetic resonance imaging (MRI), both according to Ficat and Arlet (3 studies) [13,14,17], Association Research Circulation Osseous (ARCO, 2 studies) [15,19], or Steinberg (University of Pennsylvania system, 2 studies) [12,16]. Four studies were restricted to non-traumatic AVN patients [12,15,16,19] and the other 4 articles from the same group did not specify the etiology [13,14,17,18]. The doses and duration of alendronate administration differed among the studies. In 5 of the included studies, patients were given calcium and vitamin D supplementation [12–14,17,18]. Full weight-bearing was only permitted in 1 study [15] and 4 studies only allowed partial or no weight-bearing [13,14,17,18]. Six studies reported short-term results of alendronate treatment on AVN (<4 years) [12,15–19], and the other 2 reported long-term results (≥4 years) [13,14].


Evidence for using alendronate to treat adult avascular necrosis of the femoral head: a systematic review.

Luo RB, Lin T, Zhong HM, Yan SG, Wang JA - Med. Sci. Monit. (2014)

A flow diagram demonstrates the method of article selection for clinical study inclusion.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4257480&req=5

f1-medscimonit-20-2439: A flow diagram demonstrates the method of article selection for clinical study inclusion.
Mentions: Figure 1 details study identification, inclusion, and exclusion. Our search strategy initially yielded 85 citations. Of these, we included 8 articles with 788 hips in this systematic review [12–19]. Tables 1 and 2 show the characteristics of the included articles. All the studies were conducted in Asia and published after 2000. All the studies targeted adult AVN patients within stage III classified by X-ray, magnetic resonance imaging (MRI), both according to Ficat and Arlet (3 studies) [13,14,17], Association Research Circulation Osseous (ARCO, 2 studies) [15,19], or Steinberg (University of Pennsylvania system, 2 studies) [12,16]. Four studies were restricted to non-traumatic AVN patients [12,15,16,19] and the other 4 articles from the same group did not specify the etiology [13,14,17,18]. The doses and duration of alendronate administration differed among the studies. In 5 of the included studies, patients were given calcium and vitamin D supplementation [12–14,17,18]. Full weight-bearing was only permitted in 1 study [15] and 4 studies only allowed partial or no weight-bearing [13,14,17,18]. Six studies reported short-term results of alendronate treatment on AVN (<4 years) [12,15–19], and the other 2 reported long-term results (≥4 years) [13,14].

Bottom Line: The favorable long-term results were also presented in those treated patients after 10-year follow-up.In addition, there were no severe adverse effects associated with alendronate treatment observed during short- and long-term follow-up, and most of the included studies suggested use of alendronate in early AVN with small necrotic lesion to achieve better outcomes.Level of evidence: Level 3a.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, Research Institute of Emergency Medicine, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China (mainland).

ABSTRACT
Osteonecrosis or avascular osteonecrosis (AVN) of the femoral head is a devastating multifactorial disease that affects 20 000 persons each year in the United States. The purpose of this systematic review was to determine the efficacy and safety of alendronate for adult AVN during short- and long-term follow-up. Electronic databases were searched for randomized or nonrandomized clinical trials, cohort, case-control studies, and series of cases in which alendronate was used for treatment of adult AVN of the femoral head. Relevant articles with adequate data on reduction of pain, improvement of articular function, slowing of bone collapse progression, or need for total hip arthroplasty (THA) were included after applying inclusion and exclusion criteria. Eight articles involving 788 hips with evidence level 1b to 3b were included in this systematic review. Most studies suggested a positive short-term efficacy of alendronate treatment in reducing pain, improving articular function, slowing of bone collapse progression, and delaying the need for THA for adult AVN patients. The favorable long-term results were also presented in those treated patients after 10-year follow-up. In addition, there were no severe adverse effects associated with alendronate treatment observed during short- and long-term follow-up, and most of the included studies suggested use of alendronate in early AVN with small necrotic lesion to achieve better outcomes. The findings support consideration of alendronate use for adult AVN, particularly with early stage and small necrotic size. The lack of large-scale, randomized, and double-blind studies justifies new studies to demonstrate the detailed indication and the optimized strategy of alendronate treatment. Level of evidence: Level 3a.

Show MeSH
Related in: MedlinePlus