Wang Ching-Jen, Wang Jun-Wen, Ko Jih-Yang, Weng Lin-Hsiu, Huang Chung-Cheng
Departments of Orthopedic Surgery, Chang Gung Memorial Hospital at Kaohsiung, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung, Taiwan 833.
J Bone Joint Surg Am. 2006 Feb;88(2):267-72. doi: 10.2106/JBJS.E.00051.
Bone mineral density decreases after total knee arthroplasty and is believed to affect prosthetic fixation. Treatment with alendronate has been shown to improve short-term bone mineral density after total knee arthroplasty; however, the long-term effects of this therapy are unknown. The purpose of this study was to evaluate the long-term effects of a six-month course of alendronate on bone mineral density after total knee arthroplasty.
Sixty patients were randomly assigned to receive either oral alendronate at a dosage of 10 mg/day for six months or no alendronate. The bone mineral density in the distal aspect of the femur and the proximal aspect of the tibia was measured preoperatively and at six, twelve, and thirty-six months after total knee arthroplasty.
Fifty-four patients (twenty-nine in the alendronate group and twenty-five in the control group) completed the study. The alendronate group showed significant increases in bone mineral density in the distal aspect of the femur compared with the controls at six months (+4.8% and -14.2%, respectively; p < 0.01) and twelve months (+1.6% and -11.5%, respectively; p < 0.01). No significant difference in bone mineral density was detected between the groups at thirty-six months (-3.9% and -12.2%, respectively; p = 0.08). Similar trends in bone mineral density changes were also observed in the proximal aspect of the tibia.
A six-month course of alendronate initially increased bone mineral density at six and twelve months after total knee arthroplasty, but no difference was noted after thirty-six months. The effect of alendronate on bone mineral density after total knee arthroplasty may be limited after discontinuation of therapy.
全膝关节置换术后骨密度会降低，并且据信这会影响假体固定。已表明使用阿仑膦酸盐治疗可改善全膝关节置换术后的短期骨密度；然而，这种治疗的长期效果尚不清楚。本研究的目的是评估为期六个月的阿仑膦酸盐疗程对全膝关节置换术后骨密度的长期影响。
60例患者被随机分配接受为期六个月、剂量为每日10毫克的口服阿仑膦酸盐治疗或不接受阿仑膦酸盐治疗。在全膝关节置换术前以及术后6个月、12个月和36个月测量股骨远端和胫骨近端的骨密度。
54例患者（阿仑膦酸盐组29例，对照组25例）完成了研究。与对照组相比，阿仑膦酸盐组在术后6个月时股骨远端骨密度显著增加（分别为+4.8%和-14.2%；p<0.01），在12个月时也显著增加（分别为+1.6%和-11.5%；p<0.01）。在36个月时，两组之间未检测到骨密度的显著差异（分别为-3.9%和-12.2%；p=0.08）。在胫骨近端也观察到了类似的骨密度变化趋势。
为期六个月的阿仑膦酸盐疗程最初在全膝关节置换术后6个月和12个月时增加了骨密度，但在36个月后未发现差异。在停止治疗后，阿仑膦酸盐对全膝关节置换术后骨密度的影响可能有限。
