Raloxifene Prevents Early Periprosthetic Bone Loss for Postmenopausal Women after Uncemented Total Hip Arthroplasty: A Randomized Placebo-Controlled Clinical Trial

Anti-osteoporotic drug efficacy for periprosthetic bone loss after total hip arthroplasty: A systematic review and network meta-analysis

BACKGROUND

Periprosthetic bone loss following total hip arthroplasty (THA) threatens prosthesis stability. This systematic review and network meta-analysis aimed to compare the efficacy of anti-osteoporotic drugs for measures of hip function according to functional outcomes, periprosthetic femoral bone mineral density loss in each Gruen zone, and revision surgery after THA.

METHODS

The systematic search of six literature databases was conducted in December 2021 in accordance with PRISMA guidelines. Adult participants who underwent primary THA were included. A random-effects network meta-analysis was performed within a frequentist framework, and the confidence in the evidence for each outcome was evaluated using the CINeMA tool, which assessed the credibility of results from the network meta-analysis. We included 22 randomized controlled trials (1243 participants) comparing the efficacy and safety of bisphosphonates (including etidronate, clodronate, alendronate, risedronate, pamidronate, and zoledronate), denosumab, selective estrogen receptor modulator, teriparatide, calcium + vitamin D, calcium, and vitamin D. We defined the period for revision surgery as the final follow-up period.

RESULTS

Raloxifene, bisphosphonate, calcium + vitamin D, and denosumab for prosthetic hip function might have minimal differences when compared with placebos. The magnitude of the anti-osteoporotic drug effect on periprosthetic femoral bone loss varied across different Gruen zones. Bisphosphonate, denosumab, teriparatide might be more effective than placebo in Gruen zone 1 at 12 months after THA. Additionally, bisphosphonate might be more effective than placebo in Gruen zones 2, 5, 6, and 7 at 12 months after THA. Denosumab was efficacious in preventing bone loss in Gruen zones 6 and 7 at 12 months after THA. Teriparatide was likely to be efficacious in preventing bone loss in Gruen zone 7 at 12 months after THA. Raloxifene was slightly efficacious in preventing bone loss in Gruen zones 2 and 3 at 12 months after THA. Calcium was slightly efficacious in preventing bone loss in Gruen zone 5 at 12 months after THA. None of the studies reported revision surgery.

CONCLUSIONS

Bisphosphonate and denosumab may be effective anti-osteoporotic drugs for preventing periprosthetic proximal femoral bone loss due to stress shielding after THA, particularly in cementless proximal fixation stems, which are the most commonly used prostheses worldwide.

Facile synthesis of curcumin-containing poly(amidoamine) dendrimers as pH-responsive delivery system for osteoporosis treatment

Osteoporosis is an age-related metabolic disease of bone, resulting in bone pain and even bone fragility and brittle fracture. Inhibiting overactive osteoclasts while promoting osteoblast activity is an ideal way to treat osteoporosis. Previous studies have demonstrated that natural compounds, such as curcumin (Cur) have dual roles both in promoting bone formation and inhibiting bone resorption, making them promising candidates for osteoporosis treatment. However, their poor water solubility, high dosage of curative effect and significant toxicity to other organs have largely limited their clinical translations. In this study, a novel method was reported to conjugate Cur and poly(amidoamine) dendrimers (PAD) using hexachlorocyclotriphosphazene (HCCP) as the linkage through a one-pot reaction, forming stable and uniform Cur loaded nanospheres (HCCP-Cur-PAD, HCP NPs). Owing to the hydrophilicity of PAD and hydrophobicity of Cur, HCP NPs can self-assemble into nanoparticles with particle size of 138.8 ± 78.7 nm and display excellent water dispersity. The loading capacity of Cur can reach 27.2% and it can be released from HCP NPs with pH-responsiveness. In vitro experimental results demonstrated that the HCP NPs entered lysosomes by endocytosis and proved dual anti-osteoporosis effects of inhibiting osteoclasts and promoting osteoblasts.

Risk Factors for Intraoperative Periprosthetic Femoral Fractures in Patients with Hip Dysplasia Undergoing Total Hip Arthroplasty with Uncemented Prostheses

OBJECTIVES

To determine the potential risk factors for intraoperative periprosthetic femoral fractures in patients with developmental dysplasia of the hip (DDH) undergoing total hip arthroplasty (THA).

METHODS

This was a retrospective study. Patients who were diagnosed with DDH and undergoing THA (by artificial joint replacement) at our hospital from January 1999 to December 2019 were included in this study. Clinical and radiological factors were obtained from their medical records, such as age, sex, Crowe classification, morphological features of proximal femur, and features of surgical procedure. The outcome of interest was the occurrence of intraoperative periprosthetic femoral fracture, which was recorded and classified according to the Vancouver classification system. According to the fracture status, the patients were divided into two groups: the fracture group and the non-fracture group. Multivariate logistic regression model was built to identify the risk factors for these fractures.

RESULTS

A total of 1252 hips were finally included. Intraoperative periprosthetic femoral fractures were identified in 62 hips. The incidence of intraoperative periprosthetic femoral fractures in patients with DDH undergoing THA was 4.95%. There were 22 patients (proportion = 35.48%, incidence = 1.76%) with Type A fractures, 38 (proportion = 61.29%, incidence = 3.04%) with Type B fractures, and two (proportion = 3.23%, incidence = 0.16%) with Type C fractures. Six independent risk factors for intraoperative periprosthetic femoral fractures were identified: osteoporosis (OR = 3.434; 95% CI, 1.963-6.007), previous surgical history (OR = 4.797; 95% CI, 2.446-9.410), Dorr Type A canal (OR = 3.025; 95% CI, 1.594-5.738), retained femoral neck length (OR = 1.121; 95% CI, 1.043-1.204), implanted metaphyseal-diaphyseal fixation stems (OR = 3.208; 95% CI, 1.562-6.591), and implanted stem with anteversion design (OR = 2.916; 95% CI, 1.473-5.770).

CONCLUSIONS

The overall incidence of intraoperative periprosthetic femoral fractures in patients with DDH undergoing THA was 4.95%, which was at a moderate level compared to patients with other diseases undergoing THA. Six independent risk factors were identified: osteoporosis, previous surgical history, Dorr Type A canal, insufficient neck osteotomy level, implantation of metaphyseal-diaphyseal fixation stem, and implantation of a stem with an anteversion design. Comprehending these risk factors might help surgeons prevent the occurrence of these intraoperative periprosthetic femoral fractures in patients with DDH.

Development and validation of ultra-high-performance liquid chromatography-mass spectrometry method for the determination of raloxifene and its phase II metabolites in plasma: Application to pharmacokinetic studies in rats

The aim of this study is to establish a reliable liquid chromatography-mass spectrometry method to simultaneously quantitate raloxifene, and its major metabolites, raloxifene-6-glucuronide, raloxifene-4'-glucuronide, and raloxifene-6-sulfate in rat plasma samples for pharmacokinetic studies. The separation of the analytes was achieved on a Waters BEH C₁₈ column. Water (0.1% formic acid) and acetonitrile were used as the mobile phases for elution. A one-step protein precipitation using a mixture solvent was applied for plasma sample preparation. The method was validated following the FDA guidance. The results showed that the linear range were 1.95-1000 nM for raloxifene-6-glucuronide, and raloxifene-4'-glucuronide, 0.195-100 nM for raloxifene-6-sulfate, and 0.195-200 nM for raloxifene, respectively. The lower limit of quantification was 1.95, 1.95, 0.195, and 0.195 nM for raloxifene-6-glucuronide, raloxifene-4'-glucuronide, raloxifene-6-sulfate, and raloxifene, respectively. Only 20 µl of plasma sample was required since the method is sensitive. The intra- and interday variance is <15% and the accuracy is within 85-115%. The variance of matrix effect and recovery were <15%. The method was successfully applied in a pharmacokinetic study in rats with oral administration of raloxifene.