Bone-modifying therapy in arthroplasty

The use of bisphosphonates in medicine began in the 60s of the XX century due to their ability to prevent the dissolution of hydroxyapatite and thereby to reduce bone loss. Since the mid-80s of the XX century, they began to be regularly prescribed for hypercalcemia. Currently, the most used bisphosphonate is zoledronic acid. Indications for its use are osteoporosis, metastatic bone damage and hypercalcemia caused by a malignant tumor. Denosumab, which together with zoledronic acid belongs to the pharmacological group of osteomodifying agents, is also used in these pathologies. Thе drug is used to treat giant cell tumour.

In the last 5 years, there has appeared the information on the use of bisphosphonates and denosumab to prevent aseptic instability, the most common complication of large joint endoprosthetics. According to the few data in the literature, significant improvement in periprosthetic bone mineral density is shown when using these drugs. Denosumab is more effective as compared to bisphosphonates. There is no reliable evidence of reduction in the risk of development of aseptic instability of the endoprosthesis with the use of bone-modifying agents. When prescribing bisphosphonates and denosumab, it is necessary to take into account adverse events associated with their use. In our opinion, using bone-modifying agents in patients after oncological endoprosthetics is reasonable in cases of high risk of aseptic instability. During primary endoprosthetics, their use should be avoided.

The aim of the work is to assess the effect of BMA on the condition of the periprosthetic bone after endoprosthesis, as well as their effectiveness in preventing aseptic instability during oncological endoprosthesis of long bones.

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