Background Bone marrow edema (BME) syndrome describes a clinic-radiological entity in which transient subacute or chronic joint pain is associated with characteristic MRI findings (Thiryayi et al.). The etiology remains unknown and can result in significant disability (Guerra et al). Recently, it has been shown that biphosphonates can be used to achieve a reduction in BME (Ringe et al).
Objectives Our objective was to review the cases of patients diagnosed with BME syndrome in the last 6 years which had also received at least one dose of zoledronic acid
Methods We accessed the hospital's Pharmacy database to obtain the zoledronic acid prescriptions from January 2010 to December 2015. Subsequently we selected all the patients with diagnosis of BME syndrome (chronic joint pain AND hypointense on T1-weighted and hyperintense on T2 or STIR sequences). Pain intensity (grade 0: No pain, grade 1: Mild, grade 2: Moderate and grade 3: severe) was measured at baseline, and at 3 and 12 months after treatment with zoledronic acid. MRI changes in bone edema were assessed according to the following scale: Grade 0: No change in edema, Grade 1: Decrease <50% of the initial edema, grade 2: Decrease in >50% of the initial edema, grade 3: Disappearance of bone edema. Functionality was assessed based on whether the patient had returned to his/her daily activities. Finally, complete response was defined as patient fulfilling the following characteristics: Disappearance of pain, or recovery of daily life activities and >50% decrease on bone edema from baseline on MRI.
Results 17 patients met the inclusion criteria (8 male/9 female), with a mean age of 54 years. Most commonly affected site was the ankle 9 cases (52.9%), followed by the hip: 5 cases (29.4%). 16/17 patients had baseline moderate to severe pain, and 12 months after treatment pain disappeared in 13/17. In those patients with post treatment MRI in the first 3 months (8/17), bone edema had disappeared in 5 patients (62%) and the rest of the MRIs showed a reduction of edema greater than 50%. Finally, 13 of 17 patients (76.4%) had a complete response.
Conclusions The present study shows that zoledronic acid may be a reasonable therapeutic option in bone marrow edema syndrome, as >75% of the treated patients had a complete response. This is the largest series of patients with bone marrow edema treated with zoledronic acid, but more prospective studies are needed.
Disclosure of Interest None declared