Comparison of various treatment modalities for the management of bone marrow edema syndrome/transient osteoporosis in men and non-pregnant women: a systematic review

Paraskevopoulos, Konstantinos; Keskinis, Anthimos; Vasios, Ioannis S; Makiev, Konstantinos G; Tilkeridis, Konstantinos; Drosos, Georgios I.; Ververidis, Athanasios

doi:10.1007/s00198-022-06584-8

Cited by 8 publications

(11 citation statements)

References 52 publications

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“…The cases presented here demonstrate the efficacy of surgical decompression of spontaneous BME of the knee with rapid return to function without protected weight bearing. Lastly, a 2022 systematic review comparing BME treatment modalities found that surgical decompression resulted in virtually equivalent pain resolution compared to iloprost infusion in studies examining outcomes 1–3 months postoperatively [ 32 ]. Other promising treatment modalities include non-steroidal anti-inflammatory drugs (NSAIDS), bisphosphonates, denosumab, and extracorporeal shockwave therapy (ESWT) [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Bone Marrow Edema: Perfusion Abnormalities and Treatment with Surgical Decompression

Littman

Gil

Aaron

2023

IJMS

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Bone marrow edema (BME), also termed bone marrow lesions, is a syndrome characterized by bone pain and the appearance of high signal intensity on T2 fat-suppressed and short tau inversion recovery (STIR) MRI sequences. BME can be related to trauma or a variety of non-traumatic diseases, and current treatment modalities include non-steroidal anti-inflammatory drugs (NSAIDS), bisphosphonates, denosumab, extracorporeal shockwave therapy (ESWT), the vasoactive prostacyclin analogue iloprost, and surgical decompression. Spontaneous BME is a subset that has been observed with no apparent causative conditions. It is most likely caused by venous outflow obstruction and intraosseous hypertension. These are mechanistically related to impaired perfusion and ischemia in several models of BME and are related to bone remodeling. The association of perfusion abnormalities and bone pain provides the pathophysiological rationale for surgical decompression. We present a case of spontaneous BME and a second case of spontaneous migratory BME treated with surgical decompression and demonstrate resolution of pain and the high signal intensity on MRI. This report provides an integration of the clinical syndrome, MR imaging characteristics, circulatory pathophysiology, and treatment. It draws upon several studies to suggest that both the bone pain and the MRI characteristics are related to venous stasis, and when circulatory pathologies are relieved by decompression or fenestration, both the bone pain and the MRI signal abnormalities resolve.

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Section: Discussionmentioning

confidence: 99%

Spontaneous Bone Marrow Edema: Perfusion Abnormalities and Treatment with Surgical Decompression

Littman

Gil

Aaron

2023

IJMS

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“…The knee, a joint commonly afflicted in people with moderate and severe haemophilia is the second most commonly reported site of BMOS/TO. [4][5][6] The hip is most commonly affected and ankle/foot are third-most affected sites. [4][5][6] The condition is variable in onset and severity, but in the more severe cases, as in this patient, pain is worse with weight bearing and is out of keeping with the physical exam findings, although tapping of the affected bone can illicit pain.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] The hip is most commonly affected and ankle/foot are third-most affected sites. [4][5][6] The condition is variable in onset and severity, but in the more severe cases, as in this patient, pain is worse with weight bearing and is out of keeping with the physical exam findings, although tapping of the affected bone can illicit pain. 7 Laboratory tests are often unremarkable.…”

Section: Discussionmentioning

confidence: 99%

“…8 Both HIV and haemophilia are associated with increased bone resorption and osteoporosis, with similarities in the pathophysiology including the activation of osteoclasts and reduced osteoblast activity. 3,9 The use of certain antiretroviral drugs, such as tenofovir disoproxil fumarate 10 and the protease inhibitors, 6 have been associated with reduced bone mineral density. This individual has been on a protease inhibitor (darunavir).…”

Section: Discussionmentioning

confidence: 99%

“…Management options include conservative management, bisphosphonates, iloprost infusions, extracorporeal shock wave therapy (ESWT), and cortical decompression. 6 A recent systematic review 6 has shown that bisophosphonates had the best impact on short term (<1 month) pain resolution. At 3−6 months all treatments showed equal efficacy in terms of pain resolution, but at 6-12 months cortical decompression and ESWT had the best results in terms of symptom resolution and MRI improvement.…”

Section: Discussionmentioning

confidence: 99%

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