Case series of alendronate in treatment of bone marrow edema syndrome of the hip_West China Medical Journal

Authors：

 SHI Xiaojun , KANG Pengde

Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

SHI Xiaojun, Email: shixjoint@scu.edu.cn

Keywords：

Bone marrow edema syndrome of the hip; Alendronate; Osteonecrosis of femoral head

DOI：

10.7507/1002-0179.202008202

Video：

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Objective To explore the clinical outcome of alendronate in the treatment of bone marrow edema syndrome of the hip.Methods A retrospective analysis of 8 cases (10 hips) of bone marrow edema syndrome of the hip treated with alendronate between December 2017 and January 2020 was conducted. Harris score and MRI exam of hip were used to assess the clinical and radiographical outcomes. Clinical cure rate and length of treatment period were used to evaluate whether alendronate was benefitial for the treatment of bone marrow edema syndrome of the hip.Results All the cases were followed up for at least 3 months and got complete clinical data, the mean follow-up period was (5.2±1.2) months. Seven cases (9 hips) in 8 cases (10 hips) had clinical cure, with a clinical cure rate of 90%. The length of treatment period was 1 to 2 months with a mean value of (1.7±0.2) months. The Harris score increased from 57.8±6.3 before treatment to 98.6±1.0 at the last follow-up, and the difference was statistically significant (t=18.299, P<0.001). One case (1 hip) developed osteonecrosis of femoral head at one month after the initiation of alendronate therapy, who received continuous combination therapy of alendronate, calcium and aspirin, and no collapse or expansion of necrosis was found after 12 months follow-up.Conclusions Bone marrow edema syndrome of the hip is not a self-limiting disease completely, some patients maybe develop osteonecrosis of femoral head. Alendronate is benefitial for alleviating clinical symptom, accelerating bone edema disappearance, and shortening the course of disease.

Citation： SHI Xiaojun, KANG Pengde. Case series of alendronate in treatment of bone marrow edema syndrome of the hip. West China Medical Journal, 2020, 35(10): 1201-1204. doi: 10.7507/1002-0179.202008202 Copy

1.	Curtiss PH Jr, Kincaid WE. Transitory demineralization of the hip in pregnancy: a report of three cases. J Bone Joint Surg Am, 1959, 41-A: 1327-1333.
2.	Lequesne M. Transient osteoporosis of the hip. A nontraumatic variety of Sudeck’s atrophy. Ann Rheum Dis, 1968, 27(5): 463-471.
3.	Hofmann S, Engel A, Neuhold A, et al. Bone-marrow edema syndrome and transient osteoporosis of the hip. An MRI-controlled study of treatment by core decompression. J Bone Joint Surg Br, 1993, 75(2): 210-216.
4.	胡银华, 阮玖根. 髋关节一过性骨髓水肿综合征的MRI表现. 南昌大学学报(医学版), 2011, 51(8): 87-88.
5.	张焱, 许林, 朱明双. 髋关节一过性骨髓水肿综合征与股骨头缺血坏死临床鉴别. 现代临床医学, 2015, 41(1): 19-21.
6.	Calvo E, Fernandez-Yruegas D, Alvarez L. Core decompression shortens the duration of pain in bone marrow oedema syndrome. Int Orthop, 2000, 24(2): 88-91.
7.	李勇, 何伟, 张庆文, 等. 不明原因股骨头骨髓水肿临床分型. 中国中医骨伤科杂志, 2012, 20(3): 31-32.
8.	Guerra JJ, Steinberg ME. Distinguishing transient osteoporosis from avascular necrosis of the hip. J Bone Joint Surg Am, 1995, 77(4): 616-624.
9.	Nishii T, Sugano N, Miki H, et al. Does alendronate prevent collapse in osteonecrosis of the femoral head?. Clin Orthop Relat Res, 2006, 443: 273-279.
10.	Lai KA, Shen WJ, Yang CY, et al. 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(10): 2155-2159.
11.	Agarwala S, Shah SB. Ten-year follow-up of avascular necrosis of femoral head treated with alendronate for 3 years. J Arthroplasty, 2011, 26(7): 1128-1134.
12.	Akisue T, Matsumoto K, Tsumura N, et al. Bone marrow edema syndrome associated with uterine myoma: a case report. Clin Orthop Relat Res, 2003, 409(49): 151-157.
13.	McCarthy EF. The pathology of transient regional osteoporosis. Iowa Orthop J, 1998, 18: 35-42.
14.	朱峰, 李慎江, 崔学峰, 等. 骨髓水肿与股骨头缺血性坏死分期相关性的MRI研究. 中国矫形外科杂志, 2010, 18(23): 1987-1990.
15.	Gillet C, Dalla Valle A, Gaspard N, et al. Osteonecrosis of the femoral head: lipotoxicity exacerbation in MSC and modifications of the bone marrow fluid. Endocrinology, 2017, 158(3): 490-502.
16.	Yu H, Zhu DY, Liu P, et al. Osthole stimulates bone formation, drives vascularization and retards adipogenesis to alleviate alcohol-induced osteonecrosis of the femoral head. J Cell Mol Med, 2020, 24(8): 4439-4451.
17.	Yamamoto T, Kubo T, Hirasawa Y, et al. A clinicopathologic study of transient osteoporosis of the hip. Skeletal Radiol, 1999, 28(11): 621-627.
18.	Koo KH, Ahn IO, Kim R, et al. Bone marrow edema and associated pain in early stage osteonecrosis of the femoral head: prospective study with serial Mr images. Radiology, 1999, 213(3): 715-722.
19.	Koo KH, Ahn IO, Song HR, et al. Increased perfusion of the femoral head in transient bone marrow edema syndrome. Clin Orthop Relat Res, 2002, 402(42): 171-175.
20.	Cai G, Aitken D, Laslett LL, et al. Effect of intravenous zoledronic acid on tibiofemoral cartilage volume among patients with knee osteoarthritis with bone marrow lesions: a randomized clinical trial. JAMA, 2020, 323(15): 1456-1466.

1. Curtiss PH Jr, Kincaid WE. Transitory demineralization of the hip in pregnancy: a report of three cases. J Bone Joint Surg Am, 1959, 41-A: 1327-1333.
2. Lequesne M. Transient osteoporosis of the hip. A nontraumatic variety of Sudeck’s atrophy. Ann Rheum Dis, 1968, 27(5): 463-471.
3. Hofmann S, Engel A, Neuhold A, et al. Bone-marrow edema syndrome and transient osteoporosis of the hip. An MRI-controlled study of treatment by core decompression. J Bone Joint Surg Br, 1993, 75(2): 210-216.
4. 胡银华, 阮玖根. 髋关节一过性骨髓水肿综合征的MRI表现. 南昌大学学报(医学版), 2011, 51(8): 87-88.
5. 张焱, 许林, 朱明双. 髋关节一过性骨髓水肿综合征与股骨头缺血坏死临床鉴别. 现代临床医学, 2015, 41(1): 19-21.
6. Calvo E, Fernandez-Yruegas D, Alvarez L. Core decompression shortens the duration of pain in bone marrow oedema syndrome. Int Orthop, 2000, 24(2): 88-91.
7. 李勇, 何伟, 张庆文, 等. 不明原因股骨头骨髓水肿临床分型. 中国中医骨伤科杂志, 2012, 20(3): 31-32.
8. Guerra JJ, Steinberg ME. Distinguishing transient osteoporosis from avascular necrosis of the hip. J Bone Joint Surg Am, 1995, 77(4): 616-624.
9. Nishii T, Sugano N, Miki H, et al. Does alendronate prevent collapse in osteonecrosis of the femoral head?. Clin Orthop Relat Res, 2006, 443: 273-279.
10. Lai KA, Shen WJ, Yang CY, et al. 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(10): 2155-2159.
11. Agarwala S, Shah SB. Ten-year follow-up of avascular necrosis of femoral head treated with alendronate for 3 years. J Arthroplasty, 2011, 26(7): 1128-1134.
12. Akisue T, Matsumoto K, Tsumura N, et al. Bone marrow edema syndrome associated with uterine myoma: a case report. Clin Orthop Relat Res, 2003, 409(49): 151-157.
13. McCarthy EF. The pathology of transient regional osteoporosis. Iowa Orthop J, 1998, 18: 35-42.
14. 朱峰, 李慎江, 崔学峰, 等. 骨髓水肿与股骨头缺血性坏死分期相关性的MRI研究. 中国矫形外科杂志, 2010, 18(23): 1987-1990.
15. Gillet C, Dalla Valle A, Gaspard N, et al. Osteonecrosis of the femoral head: lipotoxicity exacerbation in MSC and modifications of the bone marrow fluid. Endocrinology, 2017, 158(3): 490-502.
16. Yu H, Zhu DY, Liu P, et al. Osthole stimulates bone formation, drives vascularization and retards adipogenesis to alleviate alcohol-induced osteonecrosis of the femoral head. J Cell Mol Med, 2020, 24(8): 4439-4451.
17. Yamamoto T, Kubo T, Hirasawa Y, et al. A clinicopathologic study of transient osteoporosis of the hip. Skeletal Radiol, 1999, 28(11): 621-627.
18. Koo KH, Ahn IO, Kim R, et al. Bone marrow edema and associated pain in early stage osteonecrosis of the femoral head: prospective study with serial Mr images. Radiology, 1999, 213(3): 715-722.
19. Koo KH, Ahn IO, Song HR, et al. Increased perfusion of the femoral head in transient bone marrow edema syndrome. Clin Orthop Relat Res, 2002, 402(42): 171-175.
20. Cai G, Aitken D, Laslett LL, et al. Effect of intravenous zoledronic acid on tibiofemoral cartilage volume among patients with knee osteoarthritis with bone marrow lesions: a randomized clinical trial. JAMA, 2020, 323(15): 1456-1466.

West China Medical Journal

Case series of alendronate in treatment of bone marrow edema syndrome of the hip

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