Abstract
Summary
Bone mineral density (BMD) declined in more than half (53.7%) of post-total knee arthroplasty (TKA) patients (44 of the 82) after 1 year of oral bisphosphonate treatment, and that this decline was significant in bilateral TKA patients.
Introduction
TKA has proven to be an extremely successful procedure in terms of improving ambulatory function. However, the effects of such improvements in ambulatory function and of bisphosphonate on axial BMD have not been established. The purpose of this study was to determine the effect of 1 year of oral bisphosphonate in postmenopausal patients that have undergone TKA and to identify factors related to BMD changes using lumbar spine quantitative computed tomography (QCT).
Methods
Eighty-two postmenopausal women that underwent primary TKA for knee osteoarthritis and who received once-weekly oral alendronate 70 mg for 12 months after TKA were enrolled. The effect of 1 year of oral bisphosphonate treatment post-TKA and the factors related to general lumbar spine BMD changes by using QCT were determined.
Results
Some 53.7% of patients (44 of the 82) experienced an average lumbar spine QCT BMD decline of −6 mg/ml (range −15 to −0.5 mg/ml) after 1 year of oral bisphosphonate treatment, whereas the remaining 38 patients (46.3%) experienced an average increase of 6.8 mg/ml (range 0.6 to 15.7 mg/ml). Logistic and linear regression analysis showed that bilateral TKA was significantly related to a BMD decline (p < 0.05). Other factors, such as, age, body mass index, number of comorbidities, and Knee Society scores were not found to be significantly related to BMD response.
Conclusions
BMD declined in more than half (53.7%) of the patients after bisphosphonate treatment, and that this decline was significant in bilateral TKA patients. We believe that reduced mobility during rehabilitation was probably responsible for these BMD reductions.
Similar content being viewed by others
References
Nevitt MC, Lane NE, Scott JC, Hochberg MC, Pressman AR, Genant HK, Cummings SR (1995) Radiographic osteoarthritis of the hip and bone mineral density. Arthritis Rheum 38:907–916
Hannan MT, Anderson JJ, Zhang Y, Levy D, Felson DT (1993) Bone mineral density and knee osteoarthritis in elderly men and women. Arthritis Rheum 36:1671–1680
Arden NK, Crozier S, Smith H, Anderson F, Edwards C, Raphael H, Cooper C (2006) Knee pain, knee osteoarthritis, and the risk of fracture. Arthritis Rheum 55:610–615
Prieto-Alhambra D, Javaid MK, Judge A, Maskell J, Kiran A, Cooper C, Arden NK (2011) Bisphosphonate use and risk of post-operative fracture among patients undergoing a total knee replacement for knee osteoarthritis: a propensity score analysis. Osteoporos Int 22:1555–1571
Minoda Y, Ikebuchi M, Kobayashi H, Iwaki H, Inori F, Nakamura H (2010) A cemented mobile-bearing total knee replacement prevents periprosthetic loss of bone mineral density around the femoral component: a matched cohort study. J Bone Joint Surg Br 92-B(6):794–798
van Loon CJ, Oyen WJ, de Waal Malefijt MC, Verdonschot N (2001) Distal femoral bone mineral density after total knee arthroplasty: a comparison with general bone mineral density. Arch Orthop Trauma Surg 121:282–285
Abu-Rajab RB, Watson WS, Walker B, Roberts J, Gallacher SJ, Meek RM (2006) Peri-prosthetic bone mineral density after total knee arthroplasty: cemented versus cementless fixation. J Bone Joint Surg Br 88-B:606–613
Soininvaara TA, Jurvelin JS, Miettinen HJA, Suomalainen OT, Alhava EM, Kroger PJ (2002) Effect of alendronate on periprosthetic bone loss after total knee Arthroplasty: a one-year, randomized, controlled trial of 19 patient. Calcif Tissue Int 71:472–477
Lewiecki EM, Keaveny TM, Kopperdahl DL, Genant HK, Engelke K, Fuerst T, Kivitz A, Davies RY, Fitzpatrick LA (2009) Once-monthly oral ibandronate improves biomechanical determinants of bone strength in women with postmenopausal osteoporosis. J Clin Endocrinol Metab 94:171–180
Hochberg MC, Ross PD, Black D, Cummings SR, Genant HK, Nevitt MC, Barrett-Connor E, Musliner T, Thompson D (1999) Large increases in bone mineral density during alendronate therapy are associated with a lower risk of new vertebral fractures in women with postmenopausal osteoporosis. Arthritis Rheum 42:1246–1254
Powell RS, Pulido P, Tuason MS, Colwell CW Jr, Ezzet KA (2006) Bilateral vs unilateral total knee arthroplasty: a patient-based comparison of pain levels and recovery of ambulatory skills. J Arthroplasty 21:642–649
Sebba AI (2008) Significance of a decline in bone mineral density while receiving oral bisphosphonate treatment. Clin Ther 30:443–452
Recker RR, Gallagher R, Maccosbe PE (2005) Effect of dosing frequency on bisphosphonate medication adherence in a large longitudinal cohort of women. Mayo Clin Proc 80:856–861
Francis RM (2004) Non-response to osteoporosis treatment. J Br Menopause Soc 10:76–80
Bonnick SL, Johnston CC Jr, Kleerekoper M, Lindsay R, Miller P, Sherwood L, Siris E (2001) Importance of precision in bone density measurements. J Clin Densitom 4:105–111
Oppenheimer L, Kher U (1999) The impact of measurement error on the comparison of two treatments using a responder analysis. Stat Med 18:2177–2188
Baim S, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Lewiecki EM, Silverman S (2008) Official positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Position Development Conference. J Clin Densitom 11:75–91
Carey JJ (2005) What is a ‘failure’ of bisphosphonate therapy for osteoporosis? Cleve Clin J Med 72:1033–1039
Kilgus DJ, Shimaoka EE, Tipton JS, Eberle RW (1993) Dual-energy X-ray absorptiometry measurement of bone mineral density around porous-coated cementless femoral implants. Methods and preliminary results. J Bone Joint Surg Br 75-B:279–287
Delmas PD, Seeman E (2004) Changes in bone mineral density explain little of the reduction in vertebral or nonvertebral fracture risk with anti-resorptive therapy. Bone 34:599–604
Engelke K, Adams JE, Armbrecht G, Augat P, Bogado CE, Bouxsein ML, Felsenberg D, Ito M, Prevrhal S, Hans DB, Lewiecki EM (2008) Clinical use of quantitative computed tomography and peripheral quantitative computed tomography in the management of osteoporosis in adults. J Clin Densitom 11:123–162
Prieto-Alhambra D, Javaid MK, Judge A, Maskell J, Judge A, Nevitt M, Cooper C, Arden NK (2010) Changes in hip fracture rate before and after total knee replacement due to osteoarthritis: a population-based cohort study. Ann Rheum Dis 70:134–138
Birdsall PD, Hayes JH, Cleary R, Pinder IM, Moran CG, Sher JL (1999) Health outcome after total knee replacement in the very elderly. J Bone Joint Surg Br 81-B:660–662
Lalmohamed A, Opdam F, Arden NK, Prieto-Alhambra D, van Staa T, Leufkens HG, de Vries F (2012) Knee arthroplasty and risk of hip fracture: a population-based, case–control study. Calcif Tissue Int 90(2):144–150
Prieto-Alhambra D, Javaid MK, Judge A, Maskell J, Kiran A, de Vries F, Cooper C, Arden NK (2011) Fracture risk before and after total hip replacement in patients with osteoarthritis: potential benefits of bisphosphonate use. Arthritis Rheum 63:992–1001
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lee, J.K., Lee, C.H. & Choi, C.H. QCT bone mineral density responses to 1 year of oral bisphosphonate after total knee replacement for knee osteoarthritis. Osteoporos Int 24, 287–292 (2013). https://doi.org/10.1007/s00198-012-1925-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-012-1925-x