Abstract

ObjectiveOsteoarthritis (OA) is the most common form of arthritis worldwide. Pain and reduced function are the main symptoms in this prevalent disease. There are currently no treatments for OA that modify disease progression; therefore analgesic drugs and joint replacement for larger joints are the standard of care. In light of several recent studies reporting the use of bisphosphonates for OA treatment, our work aimed to evaluate published literature to assess the effectiveness of bisphosphonates in OA treatment.MethodsLiterature databases were searched from inception to the 30th June 2012 for clinical trials of bisphosphonates to treat OA pain. Data was appraised and levels of evidence determined qualitatively using best evidence synthesis from the Cochrane Collaboration. The two largest studies were conducted with risedronate in the treatment of knee OA, for which meta-analyses were performed for pain and functional outcomes.ResultsOur searches found 13/297 eligible studies, which included a total of 3832 participants. The trials recruited participants with OA of the hand (n = 1), knee (n = 8), knee and spine (n = 3), or hip (n = 1). Our meta-analysis of the two largest knee studies using risedronate 15 mg showed odds ratios favouring placebo interventions for the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain (1.73), WOMAC function (2.03), and WOMAC stiffness (1.82). However, 8 trials (61.5%) reported that bisphosphonates improve pain assessed by VAS scores and 2 (38.5%) reported significant improvement in WOMAC pain scores compared to control groups.ConclusionsThere is limited evidence that bisphosphonates are effective in the treatment of OA pain. Limitations of the studies we analysed included the differences in duration of bisphosphonate use, the dose and route of administration and the lack of long-term data on OA joint structure modification post-bisphosphonate therapy. Future more targeted studies are required to appreciate the value of bisphosphonates in treating osteoarthritis pain.Trial RegistrationPROSPERO Register CRD42012002541

Highlights

  • Osteoarthritis (OA) is the commonest form of arthritis worldwide and is a major cause of disability and pain

  • 8 trials (61.5%) reported that bisphosphonates improve pain assessed by visual analogue score (VAS) scores and 2 (38.5%) reported significant improvement in WOMAC pain scores compared to control groups

  • Future more targeted studies are required to appreciate the value of bisphosphonates in treating osteoarthritis pain

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Summary

Introduction

Osteoarthritis (OA) is the commonest form of arthritis worldwide and is a major cause of disability and pain. The mainstay of treatments currently approved by the UK National Institute for Health and Clinical Excellence (NICE) include pain control with oral or topical analgesic drugs e.g. NSAIDs, opioids, capsaicin, accompanied by physical therapies to maintain function [2]. In people where optimal medical management is insufficient to control symptoms, joint replacement surgery is considered in large weight bearing joints such as the hip and knee. Pain in people with OA is increasingly documented even after joint replacement surgery. In a systematic review of outcomes, the proportion of people with unfavourable long-term pain following total hip replacement (THR) ranged from 7% to 23%, and 10% to 34% following total knee replacement (TKR) [3]. There is an urgent need to address pain management in people with OA

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