Avascular necrosis of the hip is a disabling and crippling disorder. Bone functions as a closed compartment. Under certain pathological conditions, such as trauma, steroid intake and haemostatic disorders, intra-osseous bone marrow pressure increases. This increased pressure is transmitted to small venules and capillaries within the bone, causing a decrease in blood flow to the bone, i.e. ischaemia.
NEW DISCOVERY – ALENDRONATE A BISPHOSPHONATE IN THE TREATMENT OF AVASCULAR NECROSIS OF BONE
In a ground breaking discovery Dr. Sanjay Agarwala & his team has established a new
hope for painful joints stricken by Avascular Necrosis / Osteonecrosis.
Avascular necrosis (AVN) of bone is a painful, progressively disabling disorder. The hip (femoral head) is the most common site. Untreated, it progresses to frank hip arthritis needing surgical intervention (surface replacement arthroplasty or total hip replacement).
The team has been using Alendronate, a Bisphosphonate, to treat AVN of the hip for the last fifteen years with great success. Alendronate is most commonly used to treat osteoporosis. It prevents bone resorption. An initial report appeared as a letter in the Journal of Association of Physicians of India (Vo. 49, Dec’01 issue) and was awarded the Patel-Mehta Prize. Then we reported our experience of treating over 70 cases of AVN observed over 3-5 years. Most were referred for surgical treatment. In 80% of these, surgical intervention was avoided. The relief from pain was seen within a few weeks. Most become freely ambulant. Those that needed surgery had advanced disease with hip joint damage already set in. In advanced stages of AVN there is resultant osteoarthritis of the joint. This requires the management of the joint arthritis and may need hip replacement.
Concurrent animal experiments done elsewhere, independent of our studies have also confirmed the scientific efficacy of this study, and are quoted in original papers published in scientific journals.
ORAL BOSPHOHOSPHONATE –DAILY – HOW TO USE (IMPORTANT)
The tablet is to be taken on an empty stomach with one/two (preferably two) glasses of Water only. (Tea, coffee or juice WILL NOT do) and dissolves to become acidic.
While the stomach lining can withstand this acidity, bending forwards, or lying down, brings the acid to the mouth and food-pipe (esophagus). Hence after taking the tablet please do not bend forward or lie down for a period of half an hour.
Likewise eating or drinking for up to half an hour will change the acidity of the stomach and prevent the activity of the tablet. Hence, do not take anything to eat or drink for up to half an hour. Therefore, I recommend you take it before you brush your teeth in the morning and continue with the rest of your daily morning rituals like bathing / shaving etc.
Alendronate is now available as 35mg and 70mg preparation. The dose is 35 mg twice a week or 70mg weekly. (35 mg twice a week works better in the initial 3 to 6 months).
Alendronate like Bisphosphonates do not work in the absence of Calcium and Vitamin D Hence….
Please continue taking Calcium with Vitamin D Supplementation for 3 years.
Bisphosphonate Therapy : A New Paradigm In AVN Management
In 2001, Dr Sanjay Agarwala reported on AVN management with bisphosphonte therapy in medical journals. Recognizing that bisphosphontes were FDA approved and routinely used to treat osteoporotic weakened bones, he hypothesized that a viable treatment for AVN may include the use of bisphosphonates. This treatment needs to be continued for at least three years in view of the natural history of AVN and the known safety profile of bisphosphontes which too is three years. The studies done by Dr Sanjay Agarwala have shown 98% success rate in Stage I, 92% with stage II and 70% with stage III, which is far better than various studies done in the past which had a success rate of only around 30%. This pathbreaking research on bisphonate therapy in the management of AVN has paved the way for an economic mode of treatment while at the same time postponing or even avoiding the need for hip replacement surgery.