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Сообщение от doctorSergei
на правах IMHO. Покажет время.
Медикаментозной терапии состояния нет. Зачем вам назначили бисфосфонаты - для меня загадка. Область их применения - остепороз, остеоонкология и нарушения остеогенеза. аваскулярный некроз - не входит в перечень.
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Hypothetically in early stages of AVN the use of bisphosphonates could inhibit osteoclastic activity preventing subchondral bone collapse. Cardozo et al. (5) in a systematic review stated that patients affected with AVN treated with bisphosphonates had lesser pain, better mobility and lesser occurrence of femoral head collapse. They also stated that favorable results were mostly reported by noncontrolled studies. Agarwala et al. (6) studied 395 patients treated with bisphosphonates with a mean follow up of 4 years (mean 1 to 8 years). Each patient received 10 mg of alendronate per day for 3 years. Radiographic progression to head collapse was noted in 12,6% of patients with stage Ficat 1 and 55,8% with stage Ficat 2 disease. In another observational study by Agarwala et al. (7) with 10 year follow up 53 patients (Ficat 1-2-3) received 70 mg alendronate per week for 3 years. At final follow-up 87% of patients were satisfied with treatment while the other patients underwent Total Hip Arthroplasty (THA) (71% of them being classified as Ficat 3). These results are in contrast with patients not receiving any treatment at all who develop femoral head collapse in more than 70% of cases. The Authors conclude that alendronate positively alters the natural course of AVN.
Yuan et al. (8) in a recent meta-analysis of 5 randomized controlled trials found no differences in progression to head collapse, incidence of THA and Harris Hip Score (HHS) improvement except for 1 study.
The Authors concluded that there is very limited evidence to support the use of bisphosphonates in treatment of hip necrosis and that more Randomized Controlled Trials (RCT) with larger patient groups are needed. Risks of prolonged bisphosphonate treatment such as osteonecrosis of the jaw and atypical femur fractures and potential benefits should be discussed with the patient underlining the fact that this is an off-label treatment. It seems that bisphosphonate treatment in AVN is efficient in early stages of disease, however there are no clear recommendations on length of treatment and therapeutic dosage. Considering the limited evidence and potential side effects of treatment, surgical treatment is to be preferred. In patients affected by AVN in a pre-collapse stage, a 3-years treatment with alendronate 70 mg per week should be considered in selected cases.