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Effective and rapid treatment of painful localized transient osteoporosis (bone marrow edema) with intravenous ibandronate


Localized transient osteoporosis (LTO; bone marrow edema syndrome) is a rare disorder of generally unknown etiology that is characterized by acute onset of disabling bone pain. Treatment options are currently limited and largely ineffective. The locally increased bone turnover and low bone mineral density (BMD) typical of LTO indicate a potential role for bisphosphonate therapy. Ibandronate, a potent nitrogen-containing bisphosphonate, has proven efficacy in the management of postmenopausal osteoporosis and corticosteroid-induced osteoporosis when administered as a convenient intermittent intravenous (IV) injection with a between-dose interval of 2 or 3 months. In a study of 12 patients with LTO, ibandronate was administered as an initial 4-mg IV dose with a second, optional injection of 2 mg at 3 months. Daily calcium and vitamin D supplements were provided. Pain was measured at baseline and at 1, 2, 3, and 6 months using a visual analog scale (VAS) of 1–10, and BMD was measured at baseline and 6 months. IV ibandronate provided rapid and substantial pain relief. The mean (SD) VAS score decreased from 8.4 (1.3) at baseline to 0.5 (0.7) at 6 months, at which time seven patients had achieved complete pain relief. At 6 months, mean lumbar spine BMD had increased by 4.0% (range –0.8 to 7.7%) in the overall population. IV ibandronate injection affords advantages over currently available oral and IV bisphosphonates and thus offers a promising therapeutic advance in the treatment of LTO.

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  1. 1.

    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

    Article  PubMed  Google Scholar 

  2. 2.

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

    Article  PubMed  Google Scholar 

  3. 3.

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

    Article  PubMed  Google Scholar 

  4. 4.

    Schapira D (1992) Transient osteoporosis of the hip. Semin Arthritis Rheum 22:98–105

    Article  PubMed  Google Scholar 

  5. 5.

    Balakrishnan A, Schemitsch EH, Pearce D, McKee MD (2003) Distinguishing transient osteoporosis of the hip from avascular necrosis. Can J Surg 46:187–192

    PubMed  Google Scholar 

  6. 6.

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

    PubMed  Google Scholar 

  7. 7.

    Schapira D, Braun Moscovici Y, Gutierrez G, Nahir AM (2003) Severe transient osteoporosis of the hip during pregnancy. Successful treatment with intravenous bisphosphonates. Clin Exp Rheumatol 21:107–110

    PubMed  Google Scholar 

  8. 8.

    McCarthy EF (1998) The pathology of transient regional osteoporosis. Iowa Orthop J 18:35–42

    PubMed  Google Scholar 

  9. 9.

    Miller PD (2003) Efficacy and safety of long-term bisphosphonates in postmenopausal osteoporosis. Expert Opin Pharmacother 4:2253–2258

    Article  PubMed  Google Scholar 

  10. 10.

    Langston AL, Ralston SH (2004) Management of Paget’s disease of bone. Rheumatology (Oxford) 43:955–959

    Google Scholar 

  11. 11.

    Body JJ, Mancini I (2002) Bisphosphonates for cancer patients: why, how, and when? Support Care Cancer 10:399–407

    Article  PubMed  Google Scholar 

  12. 12.

    Miltner O, Niedhardt C, Piroth W, Weber M, Siebert CH (2003) Transient osteoporosis of the navicular bone in a runner. Arch Orthop Trauma Surg 123:505–508

    Article  PubMed  Google Scholar 

  13. 13.

    Samdani A, Lachmann E, Nagler W (1998) Transient osteoporosis of the hip during pregnancy: a case report. Am J Phys Med Rehabil 77:153–156

    Article  PubMed  Google Scholar 

  14. 14.

    Perucca R, Micek J (1992) Treatment of infusion-related phlebitis: review and nursing protocol. J Intraven Nurs 16:282–286

    Google Scholar 

  15. 15.

    Parker L (1999) IV devices and related infections: causes and complications. Br J Nurs 8:1494–1498

    Google Scholar 

  16. 16.

    Bandeira F, Kayath M, Marques-Neto J, et al (2003) Patient’s clinical features and compliance associated with raloxifene or alendronate after a 6-month observational Brazilian study (abstract). J Bone Miner Res 18[Suppl 2]:M352

  17. 17.

    Lombas C, Hakim C, Zanchetta J (2000) Compliance with alendronate treatment in an osteoporosis clinic (abstract) J Bone Miner Res 16[Suppl 1]:529

  18. 18.

    Hamilton B, McCoy K, Taggert H (2003) Tolerability and compliance with risedronate in clinical practice. Osteoporos Int 14:259–262

    PubMed  Google Scholar 

  19. 19.

    Mühlbauer RC, Bauss F, Schenk R, et al (1991) BM 21.0955, a potent new bisphosphonate to inhibit bone resorption. J Bone Miner Res 6:1003–1011

    PubMed  Google Scholar 

  20. 20.

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

    Article  PubMed  Google Scholar 

  21. 21.

    Tripathy D, Body JJ, Diel I, et al (2003) Oral daily ibandronate: efficacy in reducing skeletal complications in patients with metastatic bone disease from breast cancer (abstract). Proc Am Soc Clin Oncol 22:46

    Google Scholar 

  22. 22.

    Mancini I, Durman JC, Toth C, et al (2002) Short-term treatment with the bisphosphonate ibandronate for opioid-resistant metastatic bone pain (abstract). Bone 30[Suppl 3]:51

  23. 23.

    Ohlmann C, Heidenreich A (2003) Efficacy of ibandronate in the management of painful osseous metastases due to hormone refractory prostate cancer (abstract). Support Care Cancer 11:396.

    Google Scholar 

  24. 24.

    Chesnut CH, Skag A, Christiansen C, et al (2004) Effects of oral ibandronate administered daily or intermittently on fracture risk in postmenopausal osteoporosis. J Bone Miner Res 19:1241–1249

    PubMed  Google Scholar 

  25. 25.

    Ravn P, Clemmesen B, Riis BJ, Christiansen C (1996) The effect on bone mass and bone markers of different doses of ibandronate: a new bisphosphonate for prevention and treatment of postmenopausal osteoporosis: a 1-year, randomised, double-blind, placebo-controlled, dose-finding study. Bone 19:527–533

    Article  PubMed  Google Scholar 

  26. 26.

    Riis BJ, Ise J, von Stein T, Bagger Y, Christiansen C (2001) Ibandronate: a comparison of oral daily dosing versus intermittent dosing in postmenopausal osteoporosis. J Bone Miner Res 2001;16:1871–1878

    Google Scholar 

  27. 27.

    Cooper C, Emkey RD, McDonald RH, et al (2003) Efficacy and safety of oral weekly ibandronate in the treatment of postmenopausal osteoporosis. J Clin Endocrinol Metab. 88:4609–4615

    Google Scholar 

  28. 28.

    Thiébaud D, Burckhardt P, Kriegbaum H, et al (1997) Three monthly intravenous injections of ibandronate in the treatment of postmenopausal osteoporosis. Am J Med 103:298–307

    Article  PubMed  Google Scholar 

  29. 29.

    Adami S, Felsenberg D, Christiansen C, et al (2004) Efficacy and safety of ibandronate given by intravenous injection once every 3 months. Bone 34:881–889

    Article  PubMed  Google Scholar 

  30. 30.

    Recker R, Stakkestad JA, Chesnut CH, et al (2004) Clinical assessment of intravenous ibandronate injection once every 3 months in postmenopausal osteoporosis. Bone 34:890–899

    Article  PubMed  Google Scholar 

  31. 31.

    McClung MR, Wasnich RD, Recker R, et al (2004) Oral daily ibandronate prevents bone loss in early postmenopausal women without osteoporosis. J Bone Miner Res 19:11–18

    PubMed  Google Scholar 

  32. 32.

    Tanko LB, Felsenberg D, Czerwinski E, et al (2003) Oral weekly ibandronate prevents bone loss in postmenopausal women. J Intern Med 254:159–167

    Article  PubMed  Google Scholar 

  33. 33.

    Stakkestad JA, Benevolenskaya LI, Stepan JJ, et al (2003) Intravenous ibandronate injections given every three months: a new treatment option to prevent bone loss in postmenopausal women. Ann Rheum Dis 62:969–975

    Article  PubMed  Google Scholar 

  34. 34.

    Recker RR, Reid DM, Sambrook P, et al (2004) Intermittent intravenous ibandronate injection regimens provide at least equivalent efficacy to daily oral ibandronate: 1-year results from DIVA. Arthritis Rheum 50(Suppl.):4095

    Google Scholar 

  35. 35.

    Schimmer RC, Bauss F (2003) Effect of daily and intermittent use of ibandronate on bone mass and bone turnover in postmenopausal osteoporosis: a review of three phase II studies. Clin Ther 25:19–34

    Article  PubMed  Google Scholar 

  36. 36.

    Ringe JD, Dorst A, Faber J, Ibach K, Sorenson F (2003) Intermittent IV ibandronate injections reduce vertebral fracture risk in corticosteroid-induced osteoporosis: results from a long-term comparative study. Osteoporos Int 14:801–807

    Article  PubMed  Google Scholar 

  37. 37.

    Bauss F, Russell RGG (2004) Ibandronate in osteoporosis: preclinical data and rationale for intermittent dosing. Osteoporos Int 15:423–433

    Article  PubMed  Google Scholar 

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Correspondence to J. D. Ringe.

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

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  • Bisphosphonate
  • Bone marrow edema
  • Ibandronate
  • Intravenous
  • Transient osteoporosis