Single-Dose Therapy of Zoledronic Acid for the Treatment of Primary Bone Marrow Edema Syndrome.

Angelo V Vasiliadis,Anastasios Beletsiotis,George Charitoudis,Christianna Zidrou

doi:10.7759/cureus.13977

Abstract

ObjectiveTo review the patients diagnosed with bone marrow edema syndrome who had been treated with one single dose of zoledronic acid.MethodsThe data of 54 patients with bone marrow edema syndrome treated with a single dose of intravenous zoledronic acid and partial weight-bearing were included in the study. The diagnosis was based on clinical examination, the existence of prolonged pain, the presence of bone marrow edema on magnetic resonance imaging, and the patient’s medical history. The efficacy was assessed using changes in symptoms, visual analogue scale, and changes in magnetic resonance imaging.ResultsOverall, 54 patients (35.2% male) were included with bone marrow edema syndrome, with a mean age of 52.7 ± 9.77 years (range: 35 - 74 years). The most commonly affected joint was the knee in 32 patients (59.2%), followed by the foot/ankle in 13 patients (24.1%), and the hip in nine patients (16.7%). Improved mobility was reported by 29 patients (53.7%) among the total number of the patients at the six-month follow-up visit. The mean visual analogue scale was 6.77 ± 0.83, 7.25 ± 1.19, and 7.46 ± 0.96 at baseline and 5.11 ± 2.14, 4.25 ± 1.84 and 5.15 ± 2.03 at the six-month follow-up for the hip, knee and foot/ankle, respectively (p = 0.098, p < 0.001, p = 0.002). At the six-month follow-up, the MRI showed resolution of the edema in 20 out of 54 patients (approximately 37%). Only 7.4% of the patients reported minor adverse events which were resolved through a single administration of paracetamol.ConclusionOur data show that the combination treatment of a single dose of zoledronic acid and partial weight-bearing for one month improves mobility and reduces edema in patients with bone marrow edema syndrome in the primary weight-bearing joints.

Highlights

Bone marrow edema syndrome (BMES) refers to a clinical and radiological condition of uncertain etiology which is characterized by the accumulation of excessive volume of fluid in the related structures of bone marrow
7.4% of the patients reported minor adverse events which were resolved through a single administration of paracetamol
We found that a single dose of intravenous zoledronic acid, combined with partial weight-bearing, provided a good response for both clinically and radiographic outcomes in patients with BMES [5, 7, 9]

Summary

Introduction

Bone marrow edema syndrome (BMES) refers to a clinical and radiological condition of uncertain etiology which is characterized by the accumulation of excessive volume of fluid in the related structures of bone marrow. Several hypotheses for the potential pathogenesis of BMES have been described [1,2]. New clinical and histological studies on bone metabolism in BMES proposed that vitamin D deficiency may play a negative role in bone mineralization to BMES [3,4]. Vitamin D deficiency leads to a decreased calcium absorption and, the release of calcium from the bones in order to maintain circulating calcium concentrations. BMES mainly affects the hip, the knee, and the ankle joint of middle-aged males. The main symptom is pain in the affected bone with accompanying local tenderness, restricted range of motion (ROM), and inability to bear weight on the affected limb [5]

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