Hong Yu-Cai, Luo Ru-Bin, Lin Tiao, Zhong Hui-Ming, Shi Jian-Bin
Department of Emergency, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, No. 3 East Qingchun Road, Hangzhou 310008, China.
Department of Emergency, Research Institute of Emergency Medicine, Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Road, Hangzhou 310009, China.
Biomed Res Int. 2014;2014:716538. doi: 10.1155/2014/716538. Epub 2014 Nov 11.
The purpose of the current review was to determine the efficacy of alendronate for preventing collapse of femoral head in adult patients with nontraumatic avascular osteonecrosis of femoral head (ANFH). Five randomized controlled trials (RCTs) involving 305 hips were included in this review, of which 3 studies investigated alendronate versus control/placebo and the other 2 studies compared the combination of alendronate and extracorporeal shockwave therapy (ESWT) with ESWT alone. Our results suggested that even the patients with extensive necrosis encountered much less collapse in the alendronate group than control group. In these RCTs, their data also indicated a positive short- and middle-term efficacy of alendronate treatment in joint function improvement and hip pain diminishment. With the presence of the outlier study, only insignificant overall efficacy of alendronate could be observed with substantial heterogeneities. In addition, we did not find any additive benefits of alendronate in combination with ESWT for preventing collapse compared to ESWT alone. In conclusion, there is still lack of strong evidence for supporting application of alendronate in adult patients with nontraumatic ANFH, which justified that large scale, randomized, and double-blind studies should be developed to demonstrate the confirmed efficacies, detailed indication, and optimized strategy of alendronate treatment.
本综述的目的是确定阿仑膦酸盐对预防非创伤性股骨头缺血性坏死（ANFH）成年患者股骨头塌陷的疗效。本综述纳入了5项涉及305个髋关节的随机对照试验（RCT），其中3项研究比较了阿仑膦酸盐与对照组/安慰剂，另外2项研究比较了阿仑膦酸盐与体外冲击波疗法（ESWT）联合治疗与单纯ESWT治疗。我们的结果表明，即使是广泛坏死的患者，阿仑膦酸盐组的股骨头塌陷也比对照组少得多。在这些RCT中，他们的数据还表明阿仑膦酸盐治疗在改善关节功能和减轻髋关节疼痛方面具有积极的短期和中期疗效。由于存在异常值研究，仅观察到阿仑膦酸盐总体疗效不显著且存在较大异质性。此外，与单纯ESWT相比，我们未发现阿仑膦酸盐与ESWT联合使用在预防股骨头塌陷方面有任何额外益处。总之，目前仍缺乏有力证据支持在非创伤性ANFH成年患者中应用阿仑膦酸盐，这表明应开展大规模、随机、双盲研究以证实阿仑膦酸盐治疗的确切疗效、详细适应症和优化策略。
