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Treatment of bone marrow edema syndrome with intravenous Ibandronate

Abstract

Background

In this pilot study, we investigated the therapeutic efficacy of intravenous Ibandronate compared to pain medication on the outcome of bone marrow edemas (BME) of the knee and talus.

Patients and methods

Fifteen patients with a painful BME of the knee and 15 patients with a BME of the ankle, confirmed on MRI, were enrolled and treated with three ambulatory infusions of each 6 mg Ibandronate (group 1). A control group (group 2) of 10 patients with a BME of the knee and 10 patients with a BME of the talus was treated with pain medication and partial weight bearing. Patients were evaluated clinically at baseline and at 1, 3, 6 and 12 months after therapy start with a visual analog pain-scale (VAS) and specific joint scores (Larson knee- and Mazur ankle-score). BMEs were assessed with MRI at baseline and after 6 months in both groups.

Results

In the knee group, the mean VAS pain score decreased from 8.5 at baseline to 1.2 at 12 months (p < 0.0001) in patients treated with Ibandronate and, respectively, from 8.1 to 4.0 in the control group (p < 0.001). In the ankle group, the mean VAS pain score decreased from 8.2 at baseline to 0.9 at 12 months (p < 0.0001) in patients treated with Ibandronate and, respectively, from 7.9 to 3.9 in the control group (p < 0.001). The mean Mazur ankle score increased from 51 to 91 points (p < 0.001) in group 1, and from 52 to 72 points in group 2 (p < 0.01). The mean Larson knee score increased from 54 to 89 points (p < 0.001) at 12 months in group 1, and from 51 to 70 points in group 2 (p < 0.01). For both joints, we observed a significant clinical improvement in the Ibandronate treatment group and in the control group, but functional results were significantly more improved in the Ibandronate treatment group. Only the Ibandronate treatment group showed a significant BME regression at the 6 months MRI follow-up.

Conclusions

Intravenous Ibandronate therapy showed significantly better clinical results and BME regression rates on MR-imaging compared to analgesic medication in combination with partial weight bearing in the treatment of BME of the knee and talus and shortens the natural course of the disease.

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References

  1. 1.

    Bartl R, Frisch B, von Tresckow E, Bartl C (2007) Bisphosphonates in medical practice. Springer, Berlin

    Google Scholar 

  2. 2.

    Doury P (1994) Bone marrow edema, transient osteoporosis and algodystrophy. J Bone Joint Surg Br 76B:993–994

    Google Scholar 

  3. 3.

    Meizer R, Radda C, Stolz G, Kotsaris S, Petje G, Krasny C, Wlk M, Mayerhöfer M, Landsiedl F, Aigner N (2005) MRI-controlled analysis of 104 patients with painful bone marrow edema in different joint localizations treated with the prostacyclin analogue iloprost. Wien Klin Wochenschr 117:278–286

    PubMed  Article  Google Scholar 

  4. 4.

    Aigner N, Petje G, Steinboeck G, Schneider W, Krasny C, Landsiedl F (2001) Treatment of bone marrow oedema of the talus with the prostacyclin analogue iloprost. J Bone Joint Surg Br 83-B:855–858

    Article  Google Scholar 

  5. 5.

    Guerra J, Steinberg ME (1995) Distinguishing transient osteoporosis from avascular necrosis of the hip. J Bone Joint Am 77-A:616–624

    Google Scholar 

  6. 6.

    Felson DT, McLaughlin S, Goggins J, La Valley MP, Gale ME, Totterman S, Li W, Hill C, Gale D (2003) Bone marrow oedema and its relationship to progression of knee osteoarthritis. Ann Intern Med 2:330–336

    Google Scholar 

  7. 7.

    Hofmann S, Kramer J, Vakil-Adli A (2004) Painful bone marrow oedema of the knee: differential diagnosis and therapeutic concepts. Orthop Clin N Am 35:321–333

    Article  Google Scholar 

  8. 8.

    Aigner N, Petje G, Scheider W (2005) Bone marrow oedema of the femoral head: treatment with the prostacyclin analogue iloprost vs core decompression: an MRI-controlled Study. Wie Klin Wochenschr 117:130–135 (German)

    Article  Google Scholar 

  9. 9.

    Curtiss PH Jr, Kincaid WE (1959) Transitory demineralization of the hip in pregnancy: a report of three cases. J Bone Joint Surg Am 41-A:1327–1333

    PubMed  Google Scholar 

  10. 10.

    Berger CE, Kroner AH, Minai-Pour MB, Ogris E, Engel A (2003) Biochemical bone markers of bone metabolism in bone marrow oedema syndrome of the hip. Bone 33:346–351

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Korompilias AV, Karantanas AH, Lykissas MG, Beris AE (2009) Bone marrow edema syndrome. Skeletal Radiol 38:425–436

    PubMed  Article  Google Scholar 

  12. 12.

    Plenk H Jr, Hofmann S, Eschberger J, Gstettner M, Kramer J, Schneide W, Engel A (1997) Histomorphology and bone morphometry of the bone marrow edema syndrome of the hip. Clin Orthop 334:73–84

    PubMed  Google Scholar 

  13. 13.

    Bartl R, Frisch B (2007) Osteoporosis, 2nd edn. Springer, Berlin

    Google Scholar 

  14. 14.

    Arayssi TK, Tawbi HA, Usta IM, Hourani MH (2003) Calcitonin in the treatment of transient osteoporosis of the hip. Semin Arthritis Rheum 32:388–397

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Recker R, Stakkestad JA, Chesnut CH (2004) Clinical assessment of intravenous ibandronate injection once every 3 months in postmenopausal osteoporosis. Bone 82:890–899

    Article  Google Scholar 

  16. 16.

    Reid IR (2003) Bisphosphonates: new indications and methods of administration. Curr Opin Rheumatol 15:455–463

    Article  Google Scholar 

  17. 17.

    McCormack PL, Plosker GL (2006) Ibandronic acid: a review of its use in the treatment of bone metastasis of breast cancer. Drugs 66(5):711–728

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Body JJ, Diel I, Lichinitser MR (2003) Intravenous ibandronate reduces the incidence of skeletal complications in patients with breast cancer and bone metastases. J Ann Oncol 14(9):1399–1405

    Article  Google Scholar 

  19. 19.

    Ringe JD, Dorst A, Faber H (2005) Effective and rapid treatment of painful localized transient osteoporosis (bone marrow edema) with intravenous ibandronate. Osteoporos Int 16:2063–2068

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Varenna M, Zucchi F, Binelli L, Failoni S, Galleazzi M, Sinigaglia L (2002) Intravenous pamidronate in the treatment of transient osteoporosis of the hip. Bone 31:96–101

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Bartl R, Bartl C, Gradinger R (2008) Use of bisphosphonates in orthopaedic surgery. Orthopaede 37:595–614 Article in German

    Article  CAS  Google Scholar 

  22. 22.

    Stafford RS (2008) Regulating off-label drug use: rethinking the role of the FDA. N Engl J Med 358(14):1427–1429

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Smillie IS (1974) Larson score. In: Smillie IS (ed) Diseases of the knee joint. Churchill Livingstone, Edinburgh, pp 28–31

    Google Scholar 

  24. 24.

    Mazur JM, Schwartz E, Simon SR (1979) Ankle arthrodesis: long-term follow up with gait analysis. J Bone Joint Surg Am 61-A:965–975

    Google Scholar 

  25. 25.

    Disch AC, Matziolis G, Perka C (2005) The management of necrosis-associated and idiopathic bone-marrow oedema of the proximal femur by intravenous iloprost. J Bone Joint Surg Br 87-B:560–564

    Article  Google Scholar 

  26. 26.

    Schott G (1997) Bisphosphonates for pain relief in reflex sympathetic dystrophy? Lancet 350:1117–1118

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Agarwala S, Jain D, Joshi VR, Sule A (2005) Efficacy of alendronate, a bisphosphonate, in the treatment of AVN of the hip: a prospective open-label study. Rheumatology 44:352–359

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Lai KA, Shen WJ, Yang CY, Shao CJ, Hsu JT, Lin RO (2005) The use of alendronate to prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis. J Bone Joint Surg Am 87-A:2155–2159

    Article  Google Scholar 

  29. 29.

    Mayerhoefer ME, Kramer J, Breitenseher MJ, Norden C, Vakil-Adli A, Hofmann S, Meizer R, Siedentop H, Landsiedel F, Aigner N (2007) Short term outcome of painful bone marrow oedema of the knee following oral treatment with iloprost or tramadol: results of an exploratory phase II study of 41 patients. Rheumatology 46:1460–1465

    PubMed  Article  CAS  Google Scholar 

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Correspondence to Christoph Bartl.

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Bartl, C., Imhoff, A. & Bartl, R. Treatment of bone marrow edema syndrome with intravenous Ibandronate. Arch Orthop Trauma Surg 132, 1781–1788 (2012). https://doi.org/10.1007/s00402-012-1617-1

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Keywords

  • Bone marrow edema
  • Bisphosphonate
  • Ibandronate
  • Magnetic resonance imaging