MONTREAL — Three infusions of the bisphophonate ibandronate given a month apart may be all that is needed to significantly lessen clinical symptoms of bone marrow edema in most patients, according to a poster presented here at the 17th Scientific Meeting of the International Bone and Mineral Society. The treatment also improved signs of disease detected via imaging.
In a study conducted in an ambulatory setting, Dr. Christoph Bartl, of the Technical University of Munich, Germany, and colleagues gave an infusion of 6 mg of ibandronate once a month for 3 months to 42 patients with bone marrow edema (BME) confirmed by magnetic resonance imaging (MRI). The average age of patients was 43 years, and they had been experiencing BME symptoms for a mean of 4.2 months. The BME involved the ankle in 18 patients and the knee in 24. Nineteen of the cases of BME were classified as idiopathic, 13 were posttraumatic, and 10 were secondary to active osteoarthritis or mechanical stress.
The Mazur foot score, the Larson knee score, and a 0- to 10-point visual analog scale (VAS) for pain were used for clinical scoring of the effect of the intervention.
After 3 months, patients' mean VAS score dropped from 7.7 to 2.6. It dropped again to 1.8 at 6 months. Reductions in pain were significant both during rest and while the patients were active (P = <0.01).
For patients with affected ankles, Mazur score immediately following surgery was 58; after 3 months of ibandronate therapy, the score increased to 82, and increased to 89.6 after 3 months more (P = <0.05). Similarly, for patients with affected knees, Larson score increased from a preoperative 52 to 88 after 3 months of therapy and to 92 after 6 months of therapy (P = <0.05).
MRI revealed that 70% of patients experienced a significant reduction in BME size or complete normalization of the affected area with ibandronate treatment. Another 21% showed little or no change with MRI. The final 9% of patients did not undergo follow-up MRI, but three of them experienced significant clinical improvement.
Ibandronate therapy was well-tolerated overall, with 17% of patients experiencing mild acute phase reactions consisting of flulike symptoms within 2 days of receiving an infusion. Most patients—a full 86%—reported that their results with ibandronate were good or excellent.