Efeito do ácido zoledrônico e do alendronato no edema ósseo e dor na osteonecrose espontânea do joelho: Um novo paradigma no manejo

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.

Spontaneous Osteonecrosis of the Knee: a Systematic Review of Conservative Treatment Approaches

“…In this regard, Geijer et al [29] reported the course of a lesion the healing of which took over 2.5 years. By contrast, clinical symptoms often improved signi cantly after 2 to 6 weeks [13,21,22,25,29,30,33]. A complete disappearance of symptoms was described at the earliest after 2 to 3 months of continuous therapy [7,13,17].…”

“…Two case reports radiologically demonstrated the primary overlay of fracture lines by BME [28,29]. Some studies failed to report the MRI criteria used for diagnosis [30][31][32][33]. In total, BME were observed in 92.9% of patients, whereas fractures were reported to be present in 44.7%.…”

“…Sixteen of the twenty-two included studies (73%) reported positive clinical and/or radiological outcomes [7,13,17,[20][21][22][23][25][26][27][28][29][30][31][32][33]. Although RWB was the most thoroughly tested treatment modality, it has also been challenged by some authors.…”

“…Although RWB was the most thoroughly tested treatment modality, it has also been challenged by some authors. While four studies reported only moderate to poor results [14][15][16]24], nine observed favorable outcomes when testing one of the various forms of RWB [7,17,21,27,32] or a combination of RWB with bisphosphonates [20,25,29,33].…”

Osteonecrosis of the Knee

“…12,65 Iako većina pro vedenih istraživanja upućuje na povoljne učinke bis fosfonata, bitno je istaknuti da su ona provedena na malom uzorku bolesnika te da su upotrijebljeni i drugi lijekovi poput nesteroidnih protuupalnih lijekova, vitamina D i kalcija (tablica 3.). 5,12,[63][64][65][66][67] Kod primjene bisfosfonata potrebno je pratiti parametre bubrežne funkcije, jer brza intravenska primjena visokih doza može biti nefrotoksična. Kod peroralne primjene najčešće su zabilježene gastrointestinalne nuspojave poput iritacije ili erozije sluznice jednjaka, dok i kod peroralne i intravenske primjene može doći do reak cije akutne faze preosjetljivosti koja je prolazna i mani festira se simptomima sličnima gripi.…”