Ann Rehabil Med.  2019 Jun;43(3):314-320. 10.5535/arm.2019.43.3.314.

Single Dose Therapy of Zoledronic Acid for the Treatment of Transient Osteoporosis of Hip

• Agarwala S
• Vijayvargiya M

• KMID: 2453921
• DOI: http://doi.org/10.5535/arm.2019.43.3.314

Abstract

OBJECTIVE
To shorten the natural course of transient osteoporosis of hip (TOH), which is a self-limiting idiopathic condition and requires 6-12 months for the resolution of symptoms, various therapies including treatment with bisphosphonates have been attempted. There exist fewer case reports evaluating the effect of bisphosphonates in TOH and most of them lack radiographic evidence of resolution of disease. The present study was carried out with an aim to evaluate the clinical and radiological outcomes of TOH patients subsequent to treatment with a single dose of zoledronic acid.
METHODS
Data of 19 adult male and non-pregnant female patients with TOH treated with zoledronic acid were included in the study. Efficacy was assessed using changes in clinical signs and symptoms, visual analogue scale pain score, and changes in bone marrow edema (BME) in magnetic resonance imaging (MRI).
RESULTS
Mean age of the patients was 42.1 years, 17 being males. The mean time of onset of symptom was 4 weeks. Subsequent to treatment, the patients were pain-free and had no limp within an average of 2.8 weeks (range, 2-5 weeks) and remained asymptomatic at a mean follow-up of 35 months (range, 6-54 months). The post-treatment MRI showed resolution of BME in approximately 84% (16/19) of patients at 3 months. No major adverse events were reported. None of the patients progressed to avascular necrosis at their last follow-up.
CONCLUSION
Intravenous single dose administration of zoledronic acid provides early pain relief and complete reversal of TOH. Consequently, zoledronic acid is proposed as a new paradigm in the management of TOH.

Keyword

Transient osteoporosis of hip; Osteonecrosis; Bisphosphonates; Diphosphonates; Visual analog scale; Magnetic resonance imaging

MeSH Terms

Adult
Bone Marrow
Diphosphonates
Edema
Female
Follow-Up Studies
Hip*
Humans
Magnetic Resonance Imaging
Male
Necrosis
Osteonecrosis
Osteoporosis*
Visual Analog Scale
Diphosphonates

Figure

• 

  Fig. 1. Pre-treatment magnetic resonance imaging pictures of a 44-year-old patient suffering from transient osteoporosis of the left hip.

• 

  Fig. 2. Post-treatment magnetic resonance imaging pictures of the same patient at 4 months after treatment with zoledronic acid showing complete resolution of marrow edema.

• 

  Fig. 3. (A) Pre-treatment magnetic resonance imaging (MRI) pictures of a 35-year-old patient suffering from transient osteoporosis of left hip. (B) Post-treatment MRI pictures at 3 months after treatment with zoledronic acid showing complete resolution of marrow edema. (C) Clinical picture showing good functional outcome at 4 months after treatment with zoledronic acid for transient osteoporosis of hip.

Reference

1. Lakhanpal S, Ginsburg WW, Luthra HS, Hunder GG. Transient regional osteoporosis. a study of 56 cases and review of the literature. Ann Intern Med. 1987; 106:444–50.

2. Balakrishnan A, Schemitsch EH, Pearce D, McKee MD. Distinguishing transient osteoporosis of the hip from avascular necrosis. Can J Surg. 2003; 46:187–92.

3. Kibbi L, Touma Z, Khoury N, Arayssi T. Oral bisphosphonates in treatment of transient osteoporosis. Clin Rheumatol. 2008; 27:529–32.

4. Arayssi TK, Tawbi HA, Usta IM, Hourani MH. Calcitonin in the treatment of transient osteoporosis of the hip. Semin Arthritis Rheum. 2003; 32:388–97.

5. Meizer R, Meraner D, Meizer E, Radda C, Landsiedl F, Aigner N. Outcome of painful bone marrow edema of the femoral head following treatment with parenteral iloprost. Indian J Orthop. 2009; 43:36–9.

6. Emad Y, Ragab Y, El-Shaarawy N, Rasker JJ. Transient osteoporosis of the hip, complete resolution after treatment with alendronate as observed by MRI description of eight cases and review of the literature. Clin Rheumatol. 2012; 31:1641–7.

7. Seok H, Kim YT, Kim SH, Cha JG. Treatment of transient osteoporosis of the hip with intravenous zoledronate: a case report. Ann Rehabil Med. 2011; 35:432–5.

8. Vaishya R, Agarwal AK, Kumar V, Vijay V, Vaish A. Transient osteoporosis of the hip: a mysterious cause of hip pain in adults. Indian J Orthop. 2017; 51:455–60.

9. Varenna M, Zucchi F, Binelli L, Failoni S, Gallazzi M, Sinigaglia L. Intravenous pamidronate in the treatment of transient osteoporosis of the hip. Bone. 2002; 31:96–101.

10. Ringe JD, Dorst A, Faber H. Effective and rapid treatment of painful localized transient osteoporosis (bone marrow edema) with intravenous ibandronate. Osteoporos Int. 2005; 16:2063–8.

11. Waalen J. Current and emerging therapies for the treatment of osteoporosis. J Exp Pharmacol. 2010; 2:121–34.

12. Saag K, Lindsay R, Kriegman A, Beamer E, Zhou W. A single zoledronic acid infusion reduces bone resorption markers more rapidly than weekly oral alendronate in postmenopausal women with low bone mineral density. Bone. 2007; 40:1238–43.

13. Trevisan C, Ortolani S, Monteleone M, Marinoni EC. Regional migratory osteoporosis: a pathogenetic hypothesis based on three cases and a review of the literature. Clin Rheumatol. 2002; 21:418–25.

14. Harrington S, Smith J, Thompson J, Laskowski E. Idiopathic transient osteoporosis: a hidden cause of hip pain. Phys Sportsmed. 2000; 28:82–96.

15. Schapira D, Braun Moscovici Y, Gutierrez G, Nahir AM. Severe transient osteoporosis of the hip during pregnancy. Successful treatment with intravenous biphosphonates. Clin Exp Rheumatol. 2003; 21:107–10.

16. McCarthy EF. The pathology of transient regional osteoporosis. Iowa Orthop J. 1998; 18:35–42.

17. Zhao X, Hu X. Dosing of zoledronic acid with its antitumor effects in breast cancer. J Bone Oncol. 2015; 4:98–101.

18. Turner DA, Templeton AC, Selzer PM, Rosenberg AG, Petasnick JP. Femoral capital osteonecrosis: MR finding of diffuse marrow abnormalities without focal lesions. Radiology. 1989; 171:135–40.

19. Plenk H Jr, Hofmann S, Eschberger J, Gstettner M, Kramer J, Schneider W, et al. Histomorphology and bone morphometry of the bone marrow edema syndrome of the hip. Clin Orthop Relat Res. 1997; (334):73–84.

20. Yamamoto T, Kubo T, Hirasawa Y, Noguchi Y, Iwamoto Y, Sueishi K. A clinicopathologic study of transient osteoporosis of the hip. Skeletal Radiol. 1999; 28:621–7.

21. Holzer I, Snir N, Ben-Galim P, Maman E, Rosenblatt Y, Dekel S. Transient osteoporosis of the hip: long-term outcomes in men and nonpregnant women. Curr Orthop Pract. 2009; 20(2):161–3.

22. Agarwala S, Shah S, Joshi VR. The use of alendronate in the treatment of avascular necrosis of the femoral head: follow-up to eight years. J Bone Joint Surg Br. 2009; 91:1013–8.

23. Lai KA, Shen WJ, Yang CY, Shao CJ, Hsu JT, Lin RM. The use of alendronate to prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis: a randomized clinical study. J Bone Joint Surg Am. 2005; 87:2155–9.