Journal of Bone and Mineral Metabolism

, Volume 24, Issue 1, pp 87–93 | Cite as

Rapid pain relief and remission of sternocostoclavicular hyperostosis after intravenous ibandronate therapy



Sternocostoclavicular hyperostosis (SCCH) is an infrequent but painful, localized disturbance of bone metabolism of unknown etiology. The diagnosis of SCCH is generally one of exclusion, and it is therefore frequently missed or delayed, leaving patients with pain that frequently fails to respond to standard analgesic therapy. Consequently, SCCH leads to significantly impaired quality of life. Characteristic increased localized bone turnover and inflammatory osteitis provide a strong rationale for using intravenous bisphosphonates to treat the condition. We report on three patients with long-standing, treatment-refractory SCCH in whom intravenous ibandronate injections (a single administration of 4 mg followed by 2 mg every 3 months for up to a year) produced prompt, dramatic, persistent pain relief and resolution of the other symptoms of the disease. We also review recent evidence suggesting that SCCH is more common than generally believed and that technetium-99 bone scanning can aid in making an accurate diagnosis.

Key words

ibandronate sternocostoclavicular hyperostosis intravenous injection bisphosphonate pain relief remission 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kalke, S, Perera, SD, Patel, ND, Gordon, TE, Dasgupta, B 2001The sternoclavicular syndrome: experience from a district general hospital and results of a national postal surveyRheumatology40170177PubMedCrossRefGoogle Scholar
  2. 2.
    Johnston, KA, Elston, DM 1998Palmoplantar pustulosis associated with sternocostoclavicular hyperostosisCutis627576PubMedGoogle Scholar
  3. 3.
    Sanjuan Portugal, F, Manero Ruiz, FJ, Figueras Villalba, P, Martinez Alvarez, R 1995The SAPHO syndrome or psoriatic arthritis: a complicated differential diagnosis: apropos 3 cases (in Spanish)Rev Clin Esp195233236PubMedGoogle Scholar
  4. 4.
    Wilson, GS, Evans, CC 1997Sternocostoclavicular hyperostosis presenting with thoracic sinus formationThorax52305CrossRefGoogle Scholar
  5. 5.
    Ohguro, S, Kataura, A, Kukuminato, Y, Tsubota, H, Hamamoto, M, Akita, N, Shido, F 1994Tonsillectomy and osteoarthritic disease (in Japanese)Nippon Jibiinkoka Gakkai Kaiho9716011607PubMedGoogle Scholar
  6. 6.
    Finkelstein, DM, Noyek, AM 1989Sternocostoclavicular hyperostosis (SCCH) presenting as a mass in the neckJ Otolaryngol18254257PubMedGoogle Scholar
  7. 7.
    Sakata, H, Miyauchi, T, Ono, Y, Takeshita, M, Takagishi, N, Hayashi, NT, Oshitani, S 1989Usefulness of bone imaging in diagnosis of sternocostoclavicular hyperostosis (in Japanese)Radioisotopes387679PubMedGoogle Scholar
  8. 8.
    Chigira, M, Shimizu, T 1989Computed tomographic appearances of sternocostoclavicular hyperostosisSkeletal Radiol18347352PubMedCrossRefGoogle Scholar
  9. 9.
    Shimizu, T, Chigira, M 1989Roentgenological analysis of sternocostoclavicular hyperostosis by computed tomography (in Japanese)Nippon Seikeigeka Gakkai Zasshi631824PubMedGoogle Scholar
  10. 10.
    Hallas, J, Olesen, KP 1988Sterno-costo-clavicular hyperostosis: a case report with a review of the literatureActa Radiol29577579PubMedCrossRefGoogle Scholar
  11. 11.
    Freyschmidt, J, Sternberg, A 1998The bullhead sign: scintigraphic pattern of sternocostoclavicular hyperostosis and pustulotic arthroosteitisEur Radiol8807812PubMedCrossRefGoogle Scholar
  12. 12.
    Reith, JD, Bauer, TW, Schils, JP 1996Osseous manifestations of SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndromeAm J Surg Pathol2013681377PubMedCrossRefGoogle Scholar
  13. 13.
    Katz, ME, Shier, CK, Ellis, BI, Leisen, JC, Hardy, DC, Jundt, JW 1989A unified approach to symptomatic juxtasternal arthritis and enthesitisAJR Am J Roentgenol153327333PubMedGoogle Scholar
  14. 14.
    Economou, G, Jones, PB, Adams, JE, Bernstein, RM 1993Computed tomography in sternocostoclavicular hyperostosisBr J Radiol6611181124PubMedGoogle Scholar
  15. 15.
    Sons, HU, Grams, G, Danneberg, A, Dellmann, AB 1990Sternocostoclavicular hyperostosis (in German)Beitr Orthop Traumatol37661667PubMedGoogle Scholar
  16. 16.
    Hayem, G, Bouchaud-Chabot, A, Benali, K, Roux, S, Palazzo, E, Silbermann-Hoffman, O, Kahn, MF, Meyer, O 1999Sapho syndrome: a long-term follow up of 120 casesSemin Arthritis Rheum29159171PubMedCrossRefGoogle Scholar
  17. 17.
    Sonozaki, H, Azuma, A, Okai, K, Nakamura, K, Fukuoka, S, Tateishi, A, Kurosawa, H, Mannoji, T, Kabata, K, Mitsui, H, Seki, H, Abe, I, Furusawa, S, Matsuura, M, Kudo, A, Hoshino, T 1979Clinical features of 22 cases with “inter sterno-costo-clavicular ossification,” a new rheumatic syndromeArch Orthop Trauma Surg951322PubMedCrossRefGoogle Scholar
  18. 18.
    Bremner, RA 1959Monoarticular, non-infective subacute arthritis of the sternoclavicular jointJ Bone Joint Surg41B749753Google Scholar
  19. 19.
    Fleisch, H 1998Bisphosphonates: mechanisms of actionEndocr Rev1980100PubMedCrossRefGoogle Scholar
  20. 20.
    Guignard, S, Job-Deslandre, C, Sayag-Boukris, V, Kahan, A 2002Pamidronate treatment in SAPHO syndromeJoint Bone Spine69392396PubMedCrossRefGoogle Scholar
  21. 21.
    Courtney, PA, Hosking, DJ, Fairbairn, KJ, Deighton, CM 2002Treatment of SAPHO with pamidronateRheumatology (Oxford)4111961198CrossRefGoogle Scholar
  22. 22.
    Marshall, H, Bromilow, J, Thomas, AL, Arden, NK 2002Pamidronate: a novel treatment for the SAPHO syndrome?Rheumatology (Oxford)42231233CrossRefGoogle Scholar
  23. 23.
    Van Doornum, S, Barraclough, D, McColl, G, Wicks, I 2000SAPHO: rare or just not recognized?Semin Arthritis Rheum307077PubMedCrossRefGoogle Scholar
  24. 24.
    Adami, S, Zamberlan, N 1996Adverse effects of bisphosphonates: a comparative reviewDrug Saf14158170PubMedCrossRefGoogle Scholar
  25. 25.
    Chesnut, IC, Skag, A, Christiansen, C, Recker, R, Stakkestad, JA, Hoiseth, A, Felsenberg, D, Huss, H, Gilbride, J, Schimmer, RC, Delmas, PD 2004Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosisJ Bone Miner Res1912411249CrossRefGoogle Scholar
  26. 26.
    Tripathy, D, Lichinitzer, M, Lazarev, A, MacLachlan, SA, Apffelstaedt, J, Budde, M, Bergstrom, B 2004Oral ibandronate for the treatment of metastatic bone disease in breast cancer: efficacy and safety results from a randomized, double-blind, placebo-controlled trialAnn Oncol15743750PubMedCrossRefGoogle Scholar
  27. 27.
    Body, JJ, Diel, IJ, Lichinitzer, M, Lazarev, A, Pecherstorfer, M, Bell, R, Tripathy, D, Bergstrom, B 2004Oral ibandronate reduces the risk of skeletal complications in breast cancer patients with metastatic bone disease: results from two randomised, placebo-controlled phase III studiesBr J Cancer9011331137PubMedCrossRefGoogle Scholar
  28. 28.
    Kato, T, Kambara, A, Hoshi, E 1968A case with osteomyelitis of both clavicles associated with pustulosis palmaris and plantarisSeiki Geka19590593Google Scholar
  29. 29.
    Jahangier, ZN, Jacobs, JW, Bijlsma, JW 1997SAPHO syndrome: common denominator for various bone and skin diseases (in Dutch)Ned Tijdschr Geneeskd141764769PubMedGoogle Scholar
  30. 30.
    Magadum, S, Mettang, T, Meinke, J, Kuhlmann, U 1996Sternocostoclavicular hyperostosis (in German)Dtsch Med Wochenschr12114921497PubMedCrossRefGoogle Scholar
  31. 31.
    Brandt, J, Braun, J, Konig, H, Sieper, J 1995Sapho syndrome: 2 case reports (in German)Aktuelle Radiol55658PubMedGoogle Scholar
  32. 32.
    Mick, C, Kirgis, A, Noack, W 1993Sternocostoclavicular hyperostosis—case reports and differential diagnosis (in German)Z Orthop Ihre Grenzgeb131329334PubMedCrossRefGoogle Scholar
  33. 33.
    Nagel, T, Eger, G, Kalden, JR, Manger, B 1993Arthroosteitis pustulosa, spondarthritis hyperostotica pustulo-psoriatica, SAPHO syndrome: clinical experiences and review of the literature (in German)Z Rheumatol52390397PubMedGoogle Scholar
  34. 34.
    Shimauchi, A, Kondou, J, Tsuboi, H, Sone, T, Sassa, H 1993A case of a patient with sternocostoclavicular hyperostosis complaining of severe chest pain, which must be distinguished from cardiovascular disease (in Japanese)Kokyu To Junkan41277280PubMedGoogle Scholar
  35. 35.
    Dihlmann, W 1993Acquired hyperostosis syndrome (so-called pustular arthro-osteitis): review of the literature including 73 personal cases (in German)Wien Klin Wochenschr105127138PubMedGoogle Scholar
  36. 36.
    Fritz, P, Baldauf, G, Wilke, HJ, Reitter, I 1992Sternocostoclavicular hyperostosis: its progression and radiological features; a study of 12 casesAnn Rheum Dis51658664PubMedCrossRefGoogle Scholar
  37. 37.
    Wetzel, R, Gondolph-Zink, B, Puhl, W 1991Pustular osteoarthropathy and its differential diagnosisInt Orthop15101104PubMedCrossRefGoogle Scholar
  38. 38.
    Imai, H, Kodama, T, Ishino, T, Yasuda, T, Miura, AB, Asakura, K, Nishimura, S, Nakamoto, Y 1995IgA nephropathy associated with hyper IgAnemia, psoriasis or pustulosis and ossificationClin Nephrol446468PubMedGoogle Scholar
  39. 39.
    Adami, S, Felsenberg, D, Christiansen, C, Robinson, J, Lorenc, RS, Mahoney, P, Coutant, K, Schimmer, RC, Delmas, PD 2004Efficacy and safety of ibandronate given by intravenous injection once every 3 monthsBone34881889PubMedCrossRefGoogle Scholar
  40. 40.
    Hamilton, B, McCoy, K, Taggart, H 2003Tolerability and compliance with risedronate in clinical practiceOsteoporos Int14259262PubMedGoogle Scholar
  41. 41.
    Papapoulos, SE 2001

    Bisphosphonates in the management of postmenopausal osteoporosis

    Marcus, RFeldman, DKelsey, J eds. Osteoporosis2nd edn.AcademicSan Diego631649
    Google Scholar
  42. 42.
    F. Hoffmann-La Roche (2004) Bondronat European summary of product characteristicsGoogle Scholar
  43. 43.
    Ringe, JD, Dorst, A, Faber, H, Ibach, K, Sorenson, F 2003Intermittent intravenous ibandronate injections reduce vertebral fracture risk in corticosteroid-induced osteoporosis: results from a long-term comparative studyOsteoporos Int14801807PubMedCrossRefGoogle Scholar
  44. 44.
    Ringe JD (2004) Intravenous ibandronate injection is effective in treating localised transient osteoporosis. Presented at the European Congress of Rheumatology (EULAR 2004)Google Scholar

Copyright information

© Springer-Verlag Tokyo 2006

Authors and Affiliations

  • Johann D. Ringe
    • 1
  • Herbert Faber
    • 1
  • Parvis Farahmand
    • 1
  1. 1.Medizinische Klinik IV, Klinikum LeverkusenUniversity of CologneLeverkusenGermany

Personalised recommendations