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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 3, 400-404.
doi: 10.1302/0301-620X.90B3.19544  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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Bisphosphonates can block the deterioration in implant fixation after withdrawal of intermittent doses of parathyroid hormone

H. R. Johansson, BS, Medical Student, Orthopaedic Researcher1; R. Skripitz, MD, PhD, Orthopaedic Surgeon2; and P. Aspenberg, MD, PhD, Professor3

1 Department of Trauma, Hand, and Reconstructive Surgery University Hospital Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany.
2 Orthopaedic Department University Hospital Rostock, Doberanerstrasse 142, D-18055 Rostock, Germany.
3 Section for Orthopaedics and Sports Medicine, Department of Neuroscience and Locomotion, Faculty of Health Sciences, S-58183 Linköping, Sweden.

Correspondence should be sent to Dr R. Skripitz; e-mail: ralf.skripitz{at}med.uni-rostock.de

We have examined the deterioration of implant fixation after withdrawal of parathyroid hormone (PTH) in rats. First, the pull-out force for stainless-steel screws in the proximal tibia was measured at different times after withdrawal. The stimulatory effect of PTH on fixation was lost after 16 days. We then studied whether bisphosphonates could block this withdrawal effect. Mechanical and histomorphometric measurements were conducted for five weeks after implantation. Subcutaneous injections were given daily. Specimens treated with either PTH or saline during the first two weeks showed no difference in the mechanical or histological results (pull-out force 76 N vs 81 N; bone volume density 19% vs 20%). Treatment with PTH for two weeks followed by pamidronate almost doubled the pull-out force (152 N; p < 0.001) and the bone volume density (37%; ANOVA, p < 0.001). Pamidronate alone did not have this effect (89 N and 25%, respectively). Thus, the deterioration can be blocked by bisphosphonates. The clinical implications are discussed.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General