A 72-year-old man with polyostotic Paget's disease of the proximal femur requires a total hip replacement. Serum alkaline phosphatase is markedly elevated. To reduce operative blood loss and improve bone quality, the recommended preoperative measure is:
- A Administration of an intravenous bisphosphonate several weeks before surgery ✓
- B Preoperative arterial embolization of the femoral head
- C Two weeks of oral methotrexate
- D Preoperative radiotherapy to the proximal femur
Explanation
Pagetic bone is intensely hypervascular with high alkaline phosphatase reflecting osteoblastic turnover. A course of potent antiresorptive therapy such as intravenous zoledronate given weeks before elective surgery suppresses turnover, reduces vascularity and intraoperative bleeding, and improves cement and implant handling. Embolization is used for giant cell tumors and metastases, not routinely for Paget's. Methotrexate and radiotherapy are oncologic measures with no role in metabolic bone disease. Elevated ALP itself marks activity and supports medical optimization rather than proceeding untreated.
Reference: Campbell's Operative Orthopaedics, 14th ed.
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Written and medically reviewed by the StethoPrep medical team.