Clinical Orthopaedics and Related Research®

, Volume 470, Issue 9, pp 2462–2475

Evidence for Using Bisphosphonate to Treat Legg-Calvé-Perthes Disease

  • Megan L. Young
  • David G. Little
  • Harry K. W. Kim
Symposium: Legg-Calvé-Perthes Disease: Where Do We Stand After 100 Years?

Abstract

Background

The rationale for using bisphosphonate (BP) therapy for Legg-Calvé-Perthes disease (LCPD) is the potential to prevent substantial femoral head deformity during the fragmentation phase by inhibiting osteoclastic bone resorption. However, it is unclear whether BP therapy decreases femoral head deformity.

Questions/purposes

In this systematic review, we answered the following questions: (1) Does bisphosphonate (BP) therapy decrease femoral head deformity and improve pain and function in LCPD or other juvenile osteonecrotic conditions? And (2) does BP therapy decrease femoral head deformity in experimental studies of juvenile femoral head osteonecrosis?

Methods

We searched the literature from 1966 to 2011 for clinical and experimental studies on BP therapy for juvenile femoral head osteonecrosis. Studies specifically addressing clinical and/or radiographic/histologic outcomes pertaining to pain and function and femoral head morphology were analyzed.

Results

Three Level IV clinical studies met our inclusion criteria. Only one study initiated BP therapy during the precollapsed stage of osteonecrosis and reported prevention of femoral head deformity in nine of 17 patients. All studies noted subjective improvements of pain and gait in patients treated with intravenous BPs. Of the eight experimental studies reviewed, seven reported reduced femoral head deformity and six found better preservation of trabecular framework in animals treated with BPs.

Conclusions

Clinical evidence lacks consistent patient groups and drug protocols to draw definitive conclusions that BP therapy can decrease femoral head deformity in juvenile osteonecrotic conditions. Experimental studies suggest BP therapy protects the infarcted femoral head from deformity, but it lacks bone anabolic effect. Further basic and clinical research are required to determine the potential role of BPs as a medical treatment for LCPD.

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Copyright information

© The Association of Bone and Joint Surgeons® 2012

Authors and Affiliations

  • Megan L. Young
    • 1
  • David G. Little
    • 2
  • Harry K. W. Kim
    • 3
  1. 1.Texas Scottish Rite Hospital for Children, UT Southwestern Medical CenterDallasUSA
  2. 2.Department of Orthopaedic Research and BiotechnologyThe Children’s Hospital at WestmeadWestmeadAustralia
  3. 3.Center for Excellence in Hip DisordersTexas Scottish Rite Hospital for Children, UT Southwestern Medical CenterDallasUSA

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