Zoledronic Acid Treatment in Primary Bone Marrow Edema Syndrome

Abstract

Primary bone marrow edema syndrome (BMES) is characterized by the combination of joint pain and distinctive magnetic resonance imaging changes. It has been suggested that the use of bisphosphonate drugs reduce symptom severity. Our objective was to review cases of patients diagnosed with BMES in the last 7 years who had been treated with zoledronic acid. Access to a pharmaceutical database was gained in order to obtain a list of zoledronic acid prescriptions. Based on clinical and MRI criteria for BMES, patients were selected. Baseline pain intensity was evaluated on a scale of 0 to 3 and was also assessed after 3 and 12 months. Functional recovery was evaluated by noting if a patient had returned to carrying out his or her normal daily activities. Out of 633 patients, 17 cases of BMES were identified (8 men), with a median age of 54 ± 14.1 years. The most frequently affected joint was the ankle (9), followed by the hip. Sixteen patients presented with moderate to severe pain initially. Of those patients, 13 had no pain after 12 months. Zoledronic acid is a option in the management of BMES, since 75% of patients treated with it presented with a complete response.

Transient Primary Bone Marrow Edema Syndrome - A Synthesis

“…Additional modalities of treatment were explored, mainly for the TOH subtype (Table 4). In a few patients, a modern therapeutic modality, namely the intravenous administration of bisphosphonates, may have curbed the symptoms substantially [15][16][17][18][19]. In a majority of TPBMES cases, the disease was selflimited, lasting from 2 weeks to 10 months.…”

“…That is because of the necessity to try and curb the duration of the symptoms in these protracted forms of the disease. Among the unusual therapy modalities suggested by some authors one of the bisphosphonates, zoledronic acid, was administered in a single 5mg I. V. infusion, and was reported to cause a remission in a proportion of cases [18,19]. This medication given in a single dose is also advantageous in terms of the expense.…”

“…Avascular necrosis is excluded from being a TPBMES subtype, as it is neither primary nor transient. A suggested treatment is based on a single 5 mg I. V. dose of zoledronic acid [18,19]. Table 7.…”

Regional Migratory Osteoporosis: A Case Report

“…Çalışmalarda ve olgu sunumlarında medikal tedavi olarak bifosfanat, teriparatid veya prostasiklin tedavileri ile daha erken düzelme olduğu bildirilmiştir (14,17,23,24). Tedavide bifosfanatlardan alendronat, pamidronat, klodranat, ibandronat ve zoledronik asit kullanılmıştır (14,25). GBO tanısı konulan 8 hastaya alendronat 70 mg/hafta verilmiş ve 6 ay sonunda çekilen MRG'de tüm hastalarda radyolojik olarak tamamen düzelme görülmüştür (17).…”

“…Kalça tutulumu olan, GBO tanısı konulan bir hastada zoledronik asit tedavisi sonrası 4 haftada klinik iyileşme, 6 ayda radyolojik iyileşme (26), yine kalça tutulumu olan GBO tanısı konulan ve teriparatid tedavisi verilen bir hastada ise 4 haftadan sonra semptomların tamamen geçtiği 2 ay sonra ise radyolojik düzelme olduğu bildirilmiştir (27). Yapılan bir çalışmada zoledronik asit 5 mg tek doz uygulanan, GBO tanısı konulmuş 17 hastanın 15'inde 3 ay sonunda semptomların gerilediği hatta tamamen geçtiği bildirilmiştir (25). Kemik iliği ödemi olan 14 hastaya denosumab tek doz 60 mg uygulanan başka bir çalışmada, 6-12 hafta sonrasında çekilen kontrol MRG'lerde 7 hastada kemik iliği ödeminin düzeldiği, 6 hastanın MRG bulgularında ise gerileme olduğu saptanmıştır (28).…”