Perioperative alendronate, risedronate, calcitonin and indomethacin treatment alters femoral stem fixation and periprosthetic bone mineral density in ovariectomized rats

Effects of Drugs and Chemotherapeutic Agents on Dental Implant Osseointegration: Narrative Review

BACKGROUND

Dental implants have been one of the most popular treatments for rehabilitating individuals with single missing teeth or fully edentulous jaws since their introduction. As more implant patients are well-aged and take several medications due to various systemic conditions, clinicians should be mindful of possible drug implications on bone remodeling and osseointegration.

OBJECTIVE

The present study aims to study and review some desirable and some unwelcomed implications of medicine on osseointegration.

METHODS

A broad search for proper relevant studies were conducted in four databases, including Web of Science, Pubmed, Scopus, and Google Scholar.

RESULTS

Some commonly prescribed medicines such as nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, proton pump inhibitors (PPIs), selective serotonin reuptake inhibitors (SSRIs), anticoagulants, metformin, and chemotherapeutic agents may jeopardize osseointegration. On the contrary, some therapeutic agents such as anabolic, anti-catabolic, or dual anabolic and anti-catabolic agents may enhance osseointegration and increase the treatment's success rate.

CONCLUSION

Systemic medications that enhance osseointegration include mineralization promoters and bone resorption inhibitors. On the other hand, medications often given to the elderly with systemic problems might interfere with osseointegration, leading to implant failure. However, to validate the provided research, more human studies with a higher level of evidence are required.

Titania-Containing Bone Cement Shows Excellent Osteoconductivity in a Synovial Fluid Environment and Bone-Bonding Strength in Osteoporosis

Titania bone cement (TBC) reportedly has excellent in vivo bioactivity, yet its osteoconductivity in synovial fluid environments and bone-bonding ability in osteoporosis have not previously been investigated. We aimed to compare the osteoconductivity of two types of cement in a synovial fluid environment and determine their bone-bonding ability in osteoporosis. We implanted TBC and commercial polymethylmethacrylate bone cement (PBC) into rabbit femoral condyles and exposed them to synovial fluid pressure. Rabbits were then euthanized at 6, 12, and 26 weeks, and affinity indices were measured to evaluate osteoconductivity. We generated a rabbit model of osteoporosis through bilateral ovariectomy (OVX) and an 8-week treatment with methylprednisolone sodium succinate (PSL). Pre-hardened TBC and PBC were implanted into the femoral diaphysis of the rabbits in the sham control and OVX + PSL groups. Affinity indices were significantly higher for TBC than for PBC at 12 weeks (40.9 ± 16.8% versus 24.5 ± 9.02%) and 26 weeks (40.2 ± 12.7% versus 21.2 ± 14.2%). The interfacial shear strength was significantly higher for TBC than for PBC at 6 weeks (3.69 ± 1.89 N/mm² versus 1.71 ± 1.23 N/mm²) in the OVX + PSL group. These results indicate that TBC is a promising bioactive bone cement for prosthesis fixation in total knee arthroplasty, especially for osteoporosis patients.

Osseointegration Pharmacology: A Systematic Mapping Using Artificial Intelligence

Clinical performance of osseointegrated implants could be compromised by the medications taken by patients. The effect of a specific medication on osseointegration can be easily investigated using traditional systematic reviews. However, assessment of all known medications requires the use of evidence mapping methods. These methods allow assessment of complex questions, but they are very resource intensive when done manually. The objective of this study was to develop a machine learning algorithm to automatically map the literature assessing the effect of medications on osseointegration. Datasets of articles classified manually were used to train a machine-learning algorithm based on Support Vector Machines. The algorithm was then validated and used to screen 599,604 articles identified with an extremely sensitive search strategy. The algorithm included 281 relevant articles that described the effect of 31 different drugs on osseointegration. This approach achieved an accuracy of 95%, and compared to manual screening, it reduced the workload by 93%. The systematic mapping revealed that the treatment outcomes of osseointegrated medical devices could be influenced by drugs affecting homeostasis, inflammation, cell proliferation and bone remodeling. The effect of all known medications on the performance of osseointegrated medical devices can be assessed using evidence mappings executed with highly accurate machine learning algorithms.

Total hip arthroplasty in patients with osteoporosis

There is a high prevalence of osteoporosis in patients undergoing total hip arthroplasty. There are several clinically relevant questions related to the management of such cases: the effect of ageing; the initial osseointegration of implants, especially when cementless THA is used; the effect of medical osteoporosis treatment on bone-implant interface; the incidence of intraoperative and late periprosthetic fractures, and the long-term survival of both cemented and cementless total hip arthroplasty performed for proximal femoral fractures and hip osteoarthritis. A critical review of the literature is presented in an attempt to draw practical conclusions.

Effect of risedronate on femoral periprosthetic bone loss following total hip replacement: A systematic review and meta-analysis

BACKGROUND

Recent study has reported that risedronate was effective in reducing periprosthesis bone loss after total hip arthroplasty (THA). The meta-analysis was performed to compare the clinical outcomes of THA with oral risedronate versus placebo.

METHODS

Electronic databases: PubMed (1950-March 2018), EMBASE (1974-March 2018), the Cochrane Central Register of Controlled Trials, Web of Science (1950-March 2018) were systematically searched. Two authors independently graded the methodological quality of each eligible study using the Cochrane Collaboration tool and extracted relevant data. Statistical heterogeneity among the trials were evaluated with chi-square and I-square tests. This meta-analysis was performed using STATA 14.0.

RESULTS

A total of 4 randomized controlled trials (RCTs) published between 2006 and 2015 were included in our study. The meta-analysis demonstrated that risedronate was associated with a significantly reduction of periprosthetic bone mineral density after THA. No increased postoperative complications were observed.

CONCLUSION

Oral risedronate might reduce the periprosthetic bone resorption after cementless THA. Additionally, no severe adverse effects were observed. High-quality RCTs with large sample size were still required.

Effect of locally administered novel biodegradable chitosan based risedronate/zinc-hydroxyapatite intra-pocket dental film on alveolar bone density in rat model of periodontitis

The aim of this study was to develop a chitosan-based risedronate/zinc-hydroxyapatite intrapocket dental film (CRZHDF) for applications in the treatment of alveolar bone loss in an animal model of periodontitis. The physical characteristics (folding endurance, pH, mucoadhesive strength, risedronate content and release) of CRZHDF, exhibited results within the limit. X-ray diffraction analysis indicates reduced or disappeared crystallinity of risedronate and zinc-hydroxyapatite in presence of chitosan. Further, FTIR studies revealed stability of CRZHDF and compatibility between risedronate, zinc-hydroxyapatite and chitosan. Periodontitis was induced by Porphyromonas gingivalis-lipopolysaccharide injections around the mandibular first molar. We divided rats into 5 groups (12 rats/group): healthy, untreated periodontitis; periodontitis plus CRZHDF-A, periodontitis plus CRZHDF-B, and periodontitis plus chitosan film. After four weeks, blood samples and mandibles were obtained for biochemical, radiographic and histological analysis. Bone specific alkaline phosphatise activity and tartrate resistant acid phosphatase 5b was statistically lower in CRZHDF-A and CRZHDF-B groups as compared to the untreated periodontitis group (p < 0.0001). The expression of osteocalcin was statistically higher in CRZHDF-A and CRZHDF-B groups as compared to the untreated periodontitis group (p < 0.0001). Alveolar bone was intact in the healthy group. Local administration of CRZHDF resulted in significant improvements in the mesial and distal periodontal bone support (MPBS and DPBS, respectively) proportions (%), bone mineral density, and also reversed alveolar bone resorption when compared to the untreated periodontitis group (p < 0.001). The study reported here reveals that novel CRZHDF treatment effectively reduced alveolar bone destruction and contributes to periodontal healing in a rat model of experimental periodontitis.