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Use of Bisphosphonates to Improve the Durability of Total Joint Replacements

Dr. Shanbhag is Assistant Professor, Harvard Medical School, Boston, MA.

Dr. Shanbhag or the department with which he is affiliated has received research or institutional support from Merck. Dr. Shanbhag or the department with which he is affiliated has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research–related funding (such as paid travel) from Merck. Dr. Shanbhag or the department with which he is affiliated has stock or stock options held in Merck.

Supported by the National Institutes of Health NIAMS Grant AR47465 A03.

Reprint requests: Dr. Shanbhag, Massachusetts General Hospital, Biomaterials Lab, GRJ 1115, 55 Fruit Street, Boston, MA 02114.

Total joint arthroplasty is very effective for improving the quality of life of patients with end-stage arthritis. Despite advances in materials, surgical technique, and rehabilitation regimens, joint replacements are still fraught with complications leading to their premature failure. Aseptic loosening and osteolysis are the primary causes of implant failure. Other reasons include early migration of components leading to instability, lack of ingrowth into implant porosities, and bone loss caused by stress shielding. Pharmaceutical agents used for preventing and managing postmenopausal osteoporosis (eg, bisphosphonates) may in the future play an important role in improving the long-term duration of joint arthroplasties. Early findings indicate that bisphosphonates upregulate bone morphogenetic protein-2 production and stimulate new bone formation. Because of their anabolic effect on osteoblasts, bisphosphonates have the potential to enhance bone ingrowth into implant porosities, prevent bone resorption under adverse conditions, and dramatically extend the long-term durability of joint arthroplasties. The long-term effects of bisphosphonate use on the mechanical properties of bone have not been adequately investigated. Along with improvements in implant design and material properties, bisphosphonates and other pharmaceutical agents may, in the near future, be part of the growing armamentarium that provides more durable joint arthroplasties.

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