Bisphosphonate therapy is a proven method of preventing femoral head collapse in patients with avascular necrosis and subchondral lucency.
Lai et al evaluated the effect of alendronate on patients with Steinberg stage-II or III osteonecrosis of the femoral head. They found that alendronate prevented early collapse of the femoral head at twenty-four months.
Agarwala et al evaluated the effect of bisphosphonate therapy on patient reported and radiographic outcomes in femoral head avascular necrosis. They found alendronate reduces pain, improves function and may prevent disease progression at 5 year followup.
Nishii et al evaluated the effect of alendronate on 20 hips with osteonecrosis of the femoral head without collapse. They found a lower frequency of collapse and less patient reported pain in patients treated with bisphosphonate therapy compared to controls at 12 month follow up.
Thanks to Dr. Chris Rice at UW Madison:
"Recent level 1 evidence seems to cast doubt on the efficacy of bisphosphonate treatment in precolapse AVN with medium to large lesions. There is also some thought that the supposed success seen in smaller lesions is due to the natural history of these lesions which often do not progress to collapse even in the absence of any treatment. "
Lee YK, Ha YC, Cho YJ, Suh KT, Kim SY, Won YY, Min BW, Yoon TR, Kim HJ, Koo KH Does Zoledronate Prevent Femoral Head Collapse from Osteonecrosis? A Prospective, Randomized, Open-Label, Multicenter Study. J Bone Joint Surg Am. 2015 Jul 15.
Answer 1: Cyclic parathyroid hormone therapy is used in osteoporosis treatment, and not in the treatment of femoral head avascular necrosis.
Answer 3 & 4: Neither RANK nor RANK ligand are being used in therapeutic forms currently. Denosumab, an anti-RANK ligand antibody, has shown early success in the treatment of bone lysis in oncologic applications.
Answer 5: Selective estrogen receptor modulator therapy is used in osteoporosis, and not in the treatment of femoral head avascular necrosis.
Sacral Nerve Neuromodulation/Stimulation for Pelvic Floor Dysfunction
Sacroiliac Joint Fusion
Salivary Hormone Tests
Saturation Biopsy for Diagnosis, Staging, and Management of Prostate Cancer
Screening for Vertebral Fracture with Dual X-ray Absorptiometry (DXA)
Semi Implantable and Fully Implantable Middle Ear Hearing Aid
Sensory Integration Therapy
Serum Biomarker Human Epididymis Protein 4 (HE4)
Serum Biomarker Panel Testing for Systemic Lupus Erythematosus
Signal Averaged ECG
Skilled Nursing Facility Care
Skilled Nursing Services
Sleep Apnea: Diagnosis and Medical Management
Small Bowel, Small Bowel with Liver, or Multivisceral Transplant
Speech Generating Devices
Spinal Cord Stimulation
Spinal Manipulation under Anesthesia
ST2 Assay for Chronic Heart Failure
Stem-cell Therapy for Peripheral Arterial Disease
Sphenopalatine Ganglion Block for Headache
Surgery for Femoroacetabular Impingement
Surgery for Groin Pain in Athletes
Surgery for Morbid Obesity
Surgery for Obstructive Sleep Apnea and Upper Airway Resistance Syndrome
Surgical Deactivation of Headache Trigger Sites
Surgical Management of Transcatheter Heart Valves
Surgical Treatment of Chest Wall Deformities (Congenital or Acquired)
Surgical Treatment of Sinus Disease
Surgical Ventricular Restoration