In a ground breaking discovery Dr. Sanjay Agarwala & Dr. V.R. Joshi along with their teams have established new hope for painful joints stricken by Avascular Necrosis.
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).
Till date both medical (total bed rest and supportive measures) and surgical treatment like core decompression carried no more than 50% success rate.
Our group has been using Alendronate, a Bisphosphonate, to treat AVN of the hip for the last five 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 past was seen within a few weeks. Most become freely ambulant. We are now in the process of publishing our 8 year long term results which show sustained benefit with alendronate. Today it is not possible to say how long the benefit will persist, nor how long the Bisphosphonates should be taken. Presently, patients are advised to take the drug for three years.
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 or surface replacement as surgical remedies.
Concurrent animal experiments done elsewhere, independent of our studies have also confirmed the scientific efficacy of this study, and are quoted in the original papers published in scientific journals.
INSTRUCTIONS ON HOW TO USE ALENDRONATE
The tablet is to be taken on an empty stomach with one, 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 available as
Osteophos from M/s. Cipla Limited or
Restophos from M/s. Sun Pharmaceuticals in 10 mg everyday dose and 70 mg weekly dose.
In our experience once a week drug preparations are not as efficacious in the treatment of this disease and the daily regimen is recommended. In India the cost of this treatment works out to approx. Rs. 150/- a month and considering that it prevents a 1 lakh rupee operation this is a panacea in the management of these cases.
Dr. Sanjay Agarwala, Chief of Surgery, Head of Orthopaedics & Traumatology, P.D. Hinduja National Hospital.
