Abstract
PurposeThe purpose of this study was to determine the efficacy and tolerability of different antiresorptive therapeutic regimens for treating symptomatic bone marrow lesions (BML) of the knee.MethodsPatient records of 34 patients with radiologically diagnosed, painful BML of the knee treated with either a bisphosphonate (zoledronic, ibandronic, or alendronic acid) or with a human monoclonal antibody (denosumab) were retrospectively evaluated. Response to treatment was assessed, as change in patient-reported pain, by evaluation of BML expansion on MRI using the Whole-Organ Magnetic Resonance Imaging Score (WORMS), and by laboratory analysis of bone turnover markers: C-terminal cross-linking telopeptide (CTx) and procollagen type 1 amino-terminal propeptide (P1NP). Tolerability was evaluated by documentation of adverse reactions.ResultsZoledronic acid was more or at least equally effective as the other treatment regimens with response to treatment in 11 of 12 patients (92%). The highest rate of adverse events was noted in 4 of 12 patients (33%) treated with zoledronic acid. CTx and WORMS differentiated well between responders and non-responders, whereas P1NP failed to do so. Changes in pain correlated moderately with change in WORMS (r = − 0.32), weakly with change in CTx (r = − 0.07), and not at all with change in P1NP.ConclusionZoledronic acid appeared to be more effective than other antiresorptive medications—at the cost of more frequent adverse events. While radiological and laboratory evaluation methods may allow for objective treatment monitoring, they appear to capture different dimensions than patient-reported pain.Level of evidenceIII.
Highlights
Bone marrow lesions (BML) are frequently observed in magnetic resonance imaging (MRI) of the knee for various pathologic conditions [3], yet their clinical significance and the need for treatment are often unclear (Fig. 1)
Among the 12 patients treated with zoledronic acid, one failure due to the insufficient reduction of Whole-Organ Magnetic Resonance Imaging Score (WORMS) was noted
Zoledronic acid appeared to be more effective than other antiresorptive medications, especially when compared to ibandronic acid
Summary
Bone marrow lesions (BML) are frequently observed in magnetic resonance imaging (MRI) of the knee for various pathologic conditions [3], yet their clinical significance and the need for treatment are often unclear (Fig. 1). Case 1: BML after surgery, spontaneous course: MRI was ordered post-operatively because of increasing pain. Note the concordance of clinical, radiological and laboratory course. MRI was ordered because of unsatisfactory clinical course following treatment with a single administration of ibandronic acid. Case 3: traumatic BML, successful treatment: the MRI at baseline was ordered due to the unsatisfactory clinical course after surgery. Note the concordance of clinical, radiological, and laboratory course and procollagen type 1 amino-terminal propeptide (P1NP, a bone formation marker) [21], as well as vitamin D deficiencies have been reported [1, 5, 19, 20]. MR imaging has been combined with bone metabolic workup to get a better understanding of the aetiopathological processes underlying BML [9, 12], and to start an indicated treatment as early as possible
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