Annals of Rehabilitation Medicine

"Bisphosphonates"

Original Article

Single Dose Therapy of Zoledronic Acid for the Treatment of Transient Osteoporosis of Hip: Sanjay Agarwala, Mayank Vijayvargiya; Ann Rehabil Med 2019;43(3):314-320. Published online June 28, 2019; DOI: https://doi.org/10.5535/arm.2019.43.3.314

Abstract
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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.

Citations

Citations to this article as recorded by

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Case Report

A Case Report of Long-Term Bisphosphonate Therapy and Atypical Stress Fracture of Bilateral Femur: Yil Ryun Jo, Hye Won Kim, Seock Ho Moon, Young Jin Ko; Ann Rehabil Med 2013;37(3):430-432. Published online June 30, 2013; DOI: https://doi.org/10.5535/arm.2013.37.3.430

Abstract
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Bisphosphonates are potent inhibitors of bone resorption and considered as a gold standard and are generally recommended as first-line therapy in patients with osteoporosis. Though bisphosphonates are shown to significantly reduce the risk of vertebral, non-vertebral and hip fractures, recent reports suggest a possible correlation between long-term bisphosphonate therapy and the occurrence of insufficiency fractures owing to prolonged bone turnover suppression. We report a patient with non-traumatic stress fractures of bilateral femoral shafts related to long-term bisphosphonate therapy indicating the need for a critical evaluation of patients with long-term bisphosphonate therapy.

Citations

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Bilateral Atypical Femoral Shaft Fractures and Bisphosphonate Therapy; A Case Report
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