The Journal of Bone and Joint Surgery (American). 2005;87:550-557.
doi:10.2106/JBJS.D.02192
© 2005 The Journal of Bone and Joint Surgery, Inc.
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Letters to the Editor: Submit a response
Right arrow Letters to the Editor: View responses
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow Rights and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Kim, H. K.W.
Right arrow Articles by Bauss, F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kim, H. K.W.
Right arrow Articles by Bauss, F.
Related Collections
Right arrow Basic Science
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Facebook   Add to Technorati   Add to Twitter  
What's this?

Ibandronate for Prevention of Femoral Head Deformity After Ischemic Necrosis of the Capital Femoral Epiphysis in Immature Pigs

Harry K.W. Kim, MD, MSC, FRCSC1, Timothy S. Randall, BS1, Haikuo Bian, MD1, Joe Jenkins, BS1, Amanda Garces1 and Frieder Bauss, PhD2

1 Shriners Hospitals for Children, 12502 Pine Drive, Tampa, FL 33612. E-mail address for H.K.W. Kim: hkim{at}shrinenet.org
2 Roche Diagnostics, GmbH, Pharma Research, Bone Metabolism, Nonnenwald 2, Building 231, Room 321, D-82377 Penzberg, Germany

Investigation performed at the Center for Research in Skeletal Development and Pediatric Orthopaedics, Shriners Hospitals for Children, Tampa, Florida

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from Shriners Hospitals for Children and F. Hoffmann-La Roche, Ltd., Basel, Switzerland. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (F. Hoffmann-La Roche) sponsored the study.

Background: Femoral head deformity is the most serious sequela of ischemic necrosis of the immature femoral head. The purpose of this study was to determine if a highly potent antiresorptive agent, ibandronate, can inhibit bone resorption during the repair of the infarcted femoral head and thus alter the repair process. We hypothesized that preservation of the trabecular framework by inhibiting osteoclastic bone resorption would minimize the development of deformity in a piglet model of ischemic necrosis. The effect of ibandronate on long-bone growth was also assessed.

Methods: Ischemic necrosis of the right femoral head was produced in twenty-four piglets by placing a ligature tightly around the femoral neck. The animals were divided into three groups according to whether they received saline solution, prophylactic treatment, or post-ischemia treatment. The contralateral, untreated femoral heads from the animals that had received saline solution served as the normal control group. At eight weeks, the femoral heads were assessed for deformity with radiography and for trabecular bone indices with histomorphometry. Also, the length of femur from the untreated side was measured on the radiographs and compared among the groups.

Results: Radiographic assessment showed that the epiphyseal quotient, determined by dividing the maximum height of the osseous epiphysis by the maximum diameter, was better preserved in the prophylactic (p < 0.001) and post-ischemia (p = 0.02) treatment groups than in the group treated with saline solution. Histomorphometric assessment also showed that the trabecular bone indices were better preserved in the prophylactic and the post-ischemia treatment groups than in the group treated with saline solution (p < 0.01). The mean femoral length on the untreated side of the animals treated with ibandronate was reduced compared with the length on the untreated side of the animals that had received saline solution (p ≤ 0.01).

Conclusions: Ibandronate preserves the trabecular structure of the osseous epiphysis and prevents femoral head deformity during the early phase of repair of ischemic necrosis in the piglet model.

Clinical Relevance: Administration of an anti-osteolytic agent, ibandronate, during the fragmentation stage of Legg-Calvé-Perthes disease may prevent early flattening of the osseous epiphysis. Additional preclinical studies are needed to determine the optimum dose and delivery of the drug to prevent the deformity while minimizing its effect on long-bone growth. Studies are also needed to determine the long-term effects of ibandronate in terms of preventing deformity.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Facebook Facebook   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 JBJSHome page
F. Shapiro, S. Connolly, D. Zurakowski, N. Menezes, E. Olear, M. Jimenez, E. Flynn, and D. Jaramillo
Femoral Head Deformation and Repair Following Induction of Ischemic Necrosis. A Histologic and Magnetic Resonance Imaging Study in the Piglet
J. Bone Joint Surg. Am., December 1, 2009; 91(12): 2903 - 2914.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
M. Ramachandran, K. Ward, R. R. Brown, C. F. Munns, C. T. Cowell, and D. G. Little
Intravenous Bisphosphonate Therapy for Traumatic Osteonecrosis of the Femoral Head in Adolescents
J. Bone Joint Surg. Am., August 1, 2007; 89(8): 1727 - 1734.
[Abstract] [Full Text] [PDF]

Home page
 J Am Acad Orthop SurgHome page
J. Hickey, D. Lemons, P. Waber, and M. G. Seikaly
Bisphosphonate Use in Children With Bone Disease
J. Am. Acad. Ortho. Surg., November 1, 2006; 14(12): 638 - 644.
[Full Text] [PDF]

Home page
 JBJSHome page
M. A. Mont, L. C. Jones, and D. S. Hungerford
Nontraumatic Osteonecrosis of the Femoral Head: Ten Years Later
J. Bone Joint Surg. Am., May 1, 2006; 88(5): 1117 - 1132.
[Abstract] [Full Text] [PDF]

Letters to the Editor:

Read all Letters to the Editor

Drug Treatment for Prevention of Femoral Head Deformity after Necrosis of the Femoral Epiphysis
David H. Gershuni
JBJS Online, 24 May 2005 [Full text]