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.
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.
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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Bartl R, Frisch B, von Tresckow E, Bartl C (2007) Bisphosphonates in medical practice. Springer, Berlin
Doury P (1994) Bone marrow edema, transient osteoporosis and algodystrophy. J Bone Joint Surg Br 76B:993–994
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
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
Guerra J, Steinberg ME (1995) Distinguishing transient osteoporosis from avascular necrosis of the hip. J Bone Joint Am 77-A:616–624
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
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
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)
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
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
Korompilias AV, Karantanas AH, Lykissas MG, Beris AE (2009) Bone marrow edema syndrome. Skeletal Radiol 38:425–436
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
Bartl R, Frisch B (2007) Osteoporosis, 2nd edn. Springer, Berlin
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
Recker R, Stakkestad JA, Chesnut CH (2004) Clinical assessment of intravenous ibandronate injection once every 3 months in postmenopausal osteoporosis. Bone 82:890–899
Reid IR (2003) Bisphosphonates: new indications and methods of administration. Curr Opin Rheumatol 15:455–463
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
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
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
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
Bartl R, Bartl C, Gradinger R (2008) Use of bisphosphonates in orthopaedic surgery. Orthopaede 37:595–614 Article in German
Stafford RS (2008) Regulating off-label drug use: rethinking the role of the FDA. N Engl J Med 358(14):1427–1429
Smillie IS (1974) Larson score. In: Smillie IS (ed) Diseases of the knee joint. Churchill Livingstone, Edinburgh, pp 28–31
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
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
Schott G (1997) Bisphosphonates for pain relief in reflex sympathetic dystrophy? Lancet 350:1117–1118
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
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
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
About this article
Cite this article
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
- Bone marrow edema
- Magnetic resonance imaging