Download PDF
CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2020; 55(05): 543-550
DOI: 10.1016/j.rboe.2017.12.008
Artigo Original
Joelho

Effect of Zoledronic Acid and Alendronate on Bone Edema and Pain in Spontaneous Osteonecrosis of the Knee: A New Paradigm in the Medical Management[*]

Article in several languages: português | English
Sanjay Agarwala 
1   Hinduja Hospital and Medical Research Centre, Mumbai, India
,
Lokesh Sharoff
1   Hinduja Hospital and Medical Research Centre, Mumbai, India
,
Naeem Jagani
1   Hinduja Hospital and Medical Research Centre, Mumbai, India
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Objective The aim of the present study was to determine the effect of combined zoledronic acid and alendronate therapy on bone edema and knee pain in cases of spontaneous osteonecrosis of the knee. We report our experience with this treatment.

Methods A retrospective case series of 11 patients with spontaneous osteonecrosis of the knee confirmed by magnetic resonance image (MRI). The patients were treated with a single dose of 5 mg of intravenous zoledronic acid combined with 35 mg twice a week of oral alendronate, for 16 weeks. The visual analogue scale scores were noted before the beginning of the therapy, at 8 weeks, and at 16 weeks of follow-up. The size of the bone marrow edema adjacent to the lesion was measured on T2-weighted MRI coronal images at the beginning of the therapy and at 16 weeks.

Results The average visual analogue scale score at 0 weeks was of 7.72, and of 0.81 at 16 weeks of therapy; the difference was statistically significant (p = 0.03). The mean bone marrow involvement at 0 weeks was of 80%, which reduced to 11.81% at 16 weeks of therapy. This change was statistically significant (p = 0.03).

Conclusion Our data shows that the combination therapy causes early pain relief and reduction of the bone edema, and it is safe, effective and well-tolerated for a painful disease entity like spontaneous osteonecrosis of the knee.

Keywords

necrosis - bisphosphonates - osteoarthritis - knee joint

* Study conducted at the Hinduja Hospital and Medical Research Centre, Mumbai, India. Published Originally by Elsevier Editora Ltda.




Publication History

Received: 30 July 2017

Accepted: 07 December 2017

Article published online:
19 December 2019

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revnter Publicações Ltda
Rio de Janeiro, Brazil

 

  • Referências

  • 1 Ahlbäck S, Bauer GC, Bohne WH. Spontaneous osteonecrosis of the knee. Arthritis Rheum 1968; 11 (06) 705-733
    CrossrefPubMedGoogle Scholar
  • 2 Juréus J, Lindstrand A, Geijer M, Robertsson O, Tägil M. The natural course of spontaneous osteonecrosis of the knee (SPONK): a 1- to 27-year follow-up of 40 patients. Acta Orthop 2013; 84 (04) 410-414
    CrossrefPubMedGoogle Scholar
  • 3 Kraenzlin ME, Graf C, Meier C, Kraenzlin C, Friedrich NF. Possible beneficial effect of bisphosphonates in osteonecrosis of the knee. Knee Surg Sports Traumatol Arthrosc 2010; 18 (12) 1638-1644
    CrossrefPubMedGoogle Scholar
  • 4 Yamamoto T, Bullough PG. Spontaneous osteonecrosis of the knee: the result of subchondral insufficiency fracture. J Bone Joint Surg Am 2000; 82 (06) 858-866
    CrossrefPubMedGoogle Scholar
  • 5 Choy WS, Kim KJ, Lee SK, Yang DS, Kim CM, Park JS. Medial unicompartmental knee arthroplasty in patients with spontaneous osteonecrosis of the knee. Clin Orthop Surg 2011; 3 (04) 279-284
    CrossrefPubMedGoogle Scholar
  • 6 Mears SC, McCarthy EF, Jones LC, Hungerford DS, Mont MA. Characterization and pathological characteristics of spontaneous osteonecrosis of the knee. Iowa Orthop J 2009; 29: 38-42
    PubMedGoogle Scholar
  • 7 Aglietti P, Insall JN, Buzzi R, Deschamps G. Idiopathic osteonecrosis of the knee. Aetiology, prognosis and treatment. J Bone Joint Surg Br 1983; 65 (05) 588-597
    PubMedGoogle Scholar
  • 8 Son IJ, Kim MK, Kim JY, Kim JG. Osteonecrosis of the knee after arthroscopic partial meniscectomy. Knee Surg Relat Res 2013; 25 (03) 150-154
    CrossrefPubMedGoogle Scholar
  • 9 Houpt JB, Pritzker KP, Alpert B, Greyson ND, Gross AE. Natural history of spontaneous osteonecrosis of the knee (SONK): a review. Semin Arthritis Rheum 1983; 13 (02) 212-227
    CrossrefPubMedGoogle Scholar
  • 10 Karim AR, Cherian JJ, Jauregui JJ, Pierce T, Mont MA. Osteonecrosis of the knee: review. Ann Transl Med 2015; 3 (01) 6
    PubMedGoogle Scholar
  • 11 Reddy AS, Frederick RW. Evaluation of the intraosseous and extraosseous blood supply to the distal femoral condyles. Am J Sports Med 1998; 26 (03) 415-419
    PubMedGoogle Scholar
  • 12 Satku K, Kumar VP, Chong SM, Thambyah A. The natural history of spontaneous osteonecrosis of the medial tibial plateau. J Bone Joint Surg Br 2003; 85 (07) 983-988
    PubMedGoogle Scholar
  • 13 Lotke PA, Abend JA, Ecker ML. The treatment of osteonecrosis of the medial femoral condyle. Clin Orthop Relat Res 1982; (171) 109-116
    PubMedGoogle Scholar
  • 14 Agarwala S, Sule A, Pai BU, Joshi VR. Alendronate in the treatment of avascular necrosis of the hip. Rheumatology (Oxford) 2002; 41 (03) 346-347
    CrossrefPubMedGoogle Scholar
  • 15 Agarwala S, Shah S, Joshi VR. The use of alendronate in the treatment of avascular necrosis of the femoral head: follow-up to eight years. J Bone Joint Surg Br 2009; 91 (08) 1013-1018
    PubMedGoogle Scholar
  • 16 Jureus J, Lindstrand A, Geijer M, Roberts D, Tägil M. Treatment of spontaneous osteonecrosis of the knee (SPONK) by a bisphosphonate. Acta Orthop 2012; 83 (05) 511-514
    CrossrefPubMedGoogle Scholar
  • 17 Meier C, Kraenzlin C, Friederich NF. et al. Effect of ibandronate on spontaneous osteonecrosis of the knee: a randomized, double-blind, placebo-controlled trial. Osteoporos Int 2014; 25 (01) 359-366
    CrossrefPubMedGoogle Scholar
  • 18 Jäger M, Tillmann FP, Thornhill TS. et al. Rationale for prostaglandin I2 in bone marrow oedema--from theory to application. Arthritis Res Ther 2008; 10 (05) R120
    CrossrefPubMedGoogle Scholar
  • 19 Lecouvet FE, van de Berg BC, Maldague BE. et al. Early irreversible osteonecrosis versus transient lesions of the femoral condyles: prognostic value of subchondral bone and marrow changes on MR imaging. AJR Am J Roentgenol 1998; 170 (01) 71-77
    CrossrefPubMedGoogle Scholar
  • 20 Laslett LL, Doré DA, Quinn SJ. et al. Zoledronic acid reduces knee pain and bone marrow lesions over 1 year: a randomised controlled trial. Ann Rheum Dis 2012; 71 (08) 1322-1328
    CrossrefPubMedGoogle Scholar
  • 21 Porras AG, Holland SD, Gertz BJ. Pharmacokinetics of alendronate. Clin Pharmacokinet 1999; 36 (05) 315-328
    CrossrefPubMedGoogle Scholar
  • 22 Vallerand AH, Deglin JH, Sanoski CA. Davis's drug guide for nurses. 14th ed. Philadelphia: F.A. Davis Company; 2014
    Google Scholar
  • 23 Lewiecki EM. Intravenous zoledronic acid for the treatment of osteoporosis: The evidence of its therapeutic effect. Core Evid 2010; 4: 13-23
    PubMedGoogle Scholar
  • 24 Saag K, Lindsay R, Kriegman A, Beamer E, Zhou W. A single zoledronic acid infusion reduces bone resorption markers more rapidly than weekly oral alendronate in postmenopausal women with low bone mineral density. Bone 2007; 40 (05) 1238-1243
    CrossrefPubMedGoogle Scholar
  • 25 Berenson JR. Recommendations for zoledronic acid treatment of patients with bone metastases. Oncologist 2005; 10 (01) 52-62
    CrossrefPubMedGoogle Scholar
  • 26 Raynauld JP, Martel-Pelletier J, Berthiaume MJ. et al. Correlation between bone lesion changes and cartilage volume loss in patients with osteoarthritis of the knee as assessed by quantitative magnetic resonance imaging over a 24-month period. Ann Rheum Dis 2008; 67 (05) 683-688
    PubMedGoogle Scholar
  • 27 Nishii T, Sugano N, Miki H, Hashimoto J, Yoshikawa H. Does alendronate prevent collapse in osteonecrosis of the femoral head?. Clin Orthop Relat Res 2006; 443 (443) 273-279
    CrossrefPubMedGoogle Scholar
  • 28 Drake MT, Clarke BL, Khosla S. Bisphosphonates: mechanism of action and role in clinical practice. Mayo Clin Proc 2008; 83 (09) 1032-1045
    CrossrefPubMedGoogle Scholar
  • 29 Rodan GA, Fleisch HA. Bisphosphonates: mechanisms of action. J Clin Invest 1996; 97 (12) 2692-2696
    CrossrefPubMedGoogle Scholar