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Anzillotti G, Öttl FC, Franceschi C, Conte P, Bertolino EM, Lipina M, Lychagin A, Kon E, Di Matteo B. No Significant Differences between Bisphosphonates and Placebo for the Treatment of Bone Marrow Lesions of the Knee: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2024; 13:3799. [PMID: 38999364 PMCID: PMC11242668 DOI: 10.3390/jcm13133799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/22/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Abstract
Objectives: The purpose of the present systematic review and meta-analysis is to summarize the current evidence on the role of bisphosphonates in the treatment of knee bone marrow lesions (BMLs), to understand whether they are truly effective in improving symptoms and restoring the subchondral bone status at imaging evaluation. Methods: A literature search was carried out on PubMed, Cochrane, and Google Scholar databases in accordance with the PRISMA guidelines. Potential risk of bias was evaluated using the Cochrane Risk of Bias 2 tool for randomized controlled trials (RCTs) and the ROBINS-I tool for non-randomized studies. Results: A total of 15 studies were included in the present systematic review and meta-analysis. Seven studies were RCTs, two were prospective cohort studies, three were retrospective, and three were case series. Our meta-analysis revealed that bisphosphonates did not significantly improve clinical scores or reduce BML size compared to placebo. Accordingly, the rate of adverse events was also non-significantly higher among bisphosphonate users versus placebo users. Conclusions: The main finding of the present meta-analysis and systematic review is that bisphosphonates show neither significant benefits nor significant adverse events when compared to placebo in the treatment of BMLs of the knee. Level of Evidence: Level IV systematic review of level II-III-IV studies. Level I meta-analysis of level I studies.
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Affiliation(s)
- Giuseppe Anzillotti
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (P.C.); (E.K.); (B.D.M.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (C.F.); (E.M.B.)
| | - Felix C. Öttl
- Department of Hip and Knee Surgery, Schulthess Klinik, 8008 Zurich, Switzerland;
- Hospital for Special Surgery, New York, NY 10021, USA
| | - Carlotta Franceschi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (C.F.); (E.M.B.)
| | - Pietro Conte
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (P.C.); (E.K.); (B.D.M.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (C.F.); (E.M.B.)
| | - Enrico Maria Bertolino
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (C.F.); (E.M.B.)
| | - Marina Lipina
- Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov University, Moscow 119991, Russia; (M.L.); (A.L.)
- Laboratory of Clinical Smart Nanotechnologies, Sechenov University, Moscow 119991, Russia
| | - Alexey Lychagin
- Department of Traumatology, Orthopaedics and Disaster Surgery, Sechenov University, Moscow 119991, Russia; (M.L.); (A.L.)
| | - Elizaveta Kon
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (P.C.); (E.K.); (B.D.M.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (C.F.); (E.M.B.)
| | - Berardo Di Matteo
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy; (P.C.); (E.K.); (B.D.M.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy; (C.F.); (E.M.B.)
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Lin L, Zhang J, Zhu H, Wang Z, Liu X, Xu Y, Fang Y, Lin Z, Zheng Y. Bone marrow lesion and 5-year incident joint surgery in patients with knee osteoarthritis: a retrospective cohort study. J Orthop Surg Res 2024; 19:305. [PMID: 38769508 PMCID: PMC11107017 DOI: 10.1186/s13018-024-04705-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/26/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND It is beneficial for society to discover the risk factors associated with surgery and to carry out some early interventions for patients with these risk factors. Few studies specifically explored the relationship between bone marrow lesions (BMLs) and long-term incident joint surgery. OBJECTIVE To investigate the association between BML severity observed in knee osteoarthritis (OA) patients' first MRI examination and incident knee surgery within 5 years. Additionally, to assess the predictive value of BMLs for the incident knee surgery. DESIGN Retrospective cohort study. METHODS We identified patients diagnosed with knee OA and treated at our institution between January 2015 and January 2018, and retrieved their baseline clinical data and first MRI examination films from the information system. Next, we proceeded to determine the Max BML grades, BML burden grades and Presence BML grades for the medial, lateral, patellofemoral, and total compartments, respectively. Multi-variable logistic regression models examined the association of the BML grades with 5-year incident knee surgery. Positive and negative predictive values (PPVs and NPVs) were determined for BML grades referring to 5-year incident knee surgery. RESULTS Totally, 1011 participants (knees) were found eligible to form the study population. Within the 5 years, surgery was performed on 74 knees. Max BML grade 2 and grade 3 of medial, patellofemoral and total compartments were strongly and significantly associated with incident surgery. None of the BML grades from lateral compartment was associated with incident surgery. The PPV was low and NPV was high for BMLs. CONCLUSIONS BMLs found in the first MRI examination were associated with 5-year incident joint surgery, except for those allocated in lateral compartments. The high NPVs imply that patients without BMLs have a low risk of requiring surgery within 5 years.
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Affiliation(s)
- Liang Lin
- Department of Orthopedics, Jinjiang Municipal Hospital, Fujian, China
- Clinical Research Center for Orthopaedic Trauma and Reconstruction of Fujian Province, Jinjiang Municipal Hospital, Fujian, China
| | - Jinshan Zhang
- Department of Orthopedics, Jinjiang Municipal Hospital, Fujian, China.
- Clinical Research Center for Orthopaedic Trauma and Reconstruction of Fujian Province, Jinjiang Municipal Hospital, Fujian, China.
| | - Hongyi Zhu
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
- Institute of Clinical Research, National Center for Orthopaedics, Shanghai Sixth People's Hospital, Shanghai, China
| | - Zefeng Wang
- Department of Orthopedics, Jinjiang Municipal Hospital, Fujian, China
- Clinical Research Center for Orthopaedic Trauma and Reconstruction of Fujian Province, Jinjiang Municipal Hospital, Fujian, China
| | - Xiaofeng Liu
- Department of Orthopedics, Jinjiang Municipal Hospital, Fujian, China
- Clinical Research Center for Orthopaedic Trauma and Reconstruction of Fujian Province, Jinjiang Municipal Hospital, Fujian, China
| | - Yongquan Xu
- Department of Orthopedics, Jinjiang Municipal Hospital, Fujian, China
- Clinical Research Center for Orthopaedic Trauma and Reconstruction of Fujian Province, Jinjiang Municipal Hospital, Fujian, China
| | - Yangzhen Fang
- Department of Orthopedics, Jinjiang Municipal Hospital, Fujian, China
- Clinical Research Center for Orthopaedic Trauma and Reconstruction of Fujian Province, Jinjiang Municipal Hospital, Fujian, China
| | - Zhenyu Lin
- Department of Orthopedics, Jinjiang Municipal Hospital, Fujian, China
- Clinical Research Center for Orthopaedic Trauma and Reconstruction of Fujian Province, Jinjiang Municipal Hospital, Fujian, China
| | - Yongqiang Zheng
- Department of Orthopedics, Jinjiang Municipal Hospital, Fujian, China
- Clinical Research Center for Orthopaedic Trauma and Reconstruction of Fujian Province, Jinjiang Municipal Hospital, Fujian, China
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Subbu K, Renner JB, Rubin JE. Extensive Osteonecrosis After Glucocorticoids: Clinical Response to Bisphosphonate. JCEM CASE REPORTS 2023; 1:luac006. [PMID: 37908238 PMCID: PMC10578391 DOI: 10.1210/jcemcr/luac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Indexed: 11/02/2023]
Abstract
Osteonecrosis is a devastating complication of long-term glucocorticoid therapy that has been described in both malignant and nonmalignant diseases. Its incidence has been found to greater than 50% using magnetic resonance imaging in asymptomatic patients, thus osteonecrosis is likely underdiagnosed. Recent studies have suggested that treatment with bisphosphonates can improve pain and mobility and decrease bone marrow edema. We describe a patient with acute lymphoblastic leukemia who presented with debilitating osteonecrosis after treatment with prednisone for a total cumulative dose of 5100 mg. Magnetic resonance imaging revealed extensive infarcts of her bilateral tibiae and femora and left humerus, talus, and calcaneus consistent with osteonecrosis that had persisted for more than 2 years. Her severe knee, shoulder, and ankle pain was treated with 1 dose zolendronic acid. Despite a prolonged acute phase reaction, the patient's symptoms improved with near total resolution of pain.
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Affiliation(s)
- Karthik Subbu
- Division of Endocrinology, Diabetes, and Metabolism, University of North Carolina, NC 27514, USA
| | - Jordan B Renner
- Departments of Radiology and Health Sciences, University of North Carolina, NC 27514, USA
| | - Janet E Rubin
- Division of Endocrinology, Diabetes, and Metabolism, University of North Carolina, NC 27514, USA
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Walsh DA, Sofat N, Guermazi A, Hunter DJ. Osteoarthritis Bone Marrow Lesions. Osteoarthritis Cartilage 2023; 31:11-17. [PMID: 36191832 DOI: 10.1016/j.joca.2022.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/19/2022] [Accepted: 09/24/2022] [Indexed: 02/02/2023]
Abstract
Assessment and treatment of Bone Marrow Lesions (BMLs) could ultimately make step changes to the lives of people with osteoarthritis (OA). We here review the imaging and pathological characteristics of OA-BMLs, their differential diagnosis and measurement, and cross-sectional and longitudinal associations with pain and OA structural progression. We discuss how biomechanical and cellular factors may contribute to BML pathogenesis, and how pharmacological and non-pharmacological interventions that target BMLs might reduce pain and OA structural progression. We critically appraise semiquantitative and quantitative methods for assessing BMLs, and their potential utilities for identifying people at risk of symptomatic and structural OA progression, and evaluating treatment responses. New interventions that target OA-BMLs should both confirm their importance, and reduce the unacceptable burden of OA.
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Affiliation(s)
- D A Walsh
- Professor of Rheumatology, Pain Centre Versus Arthritis, NIHR Nottingham Biomedical Research Centre, Academic Rheumatology, Division of Injury, Inflammation and Recovery, School of Medicine, University of Nottingham Clinical Sciences Building, City Hospital, Hucknall Road, Nottingham, NG5 1PB, United Kingdom; Consultant Rheumatologist, Sherwood Forest Hospitals NHS Foundation Trust, Mansfield Road, Sutton in Ashfield, NG17 4JL, United Kingdom.
| | - N Sofat
- Professor of Rheumatology, Institute for Infection and Immunity, St George's University of London, Cranmer Terrace, London, SW17 ORE, United Kingdom; Consultant Rheumatologist, St George's University Hospitals NHS Trust, London, SW17 OPQ, United Kingdom.
| | - A Guermazi
- Professor of Radiology, Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, United States.
| | - D J Hunter
- Professor of Medicine, Sydney Musculoskeletal Health, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia.
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Influence of Vitamin D and C on Bone Marrow Edema Syndrome-A Scoping Review of the Literature. J Clin Med 2022; 11:jcm11226820. [PMID: 36431295 PMCID: PMC9696648 DOI: 10.3390/jcm11226820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/13/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
Bone marrow edema syndrome (BMES) is a rare disease with a largely unknown etiology. The aim of this scoping review is to systematically evaluate and combine the available evidence about vitamin D and C and BMES. The analysis of the manuscripts was based on country of origin, number of patients, gender, study type, epidemiology, localization, bone mineral density measurements, vitamin status and therapy. Sixty studies were included. The overall number of patients was 823 with a male-to-female ratio of 1.55:1 and a mean age of 40.9 years. Studies were very heterogeneous and of diverging scientific scope with a weak level of evidence. The hip was the most affected joint, followed by the foot and ankle and the knee; 18.3% of patients suffered from multifocal BMES. Sixteen studies reported on vitamin D levels, resulting in a high prevalence of vitamin D deficiency (47%) and insufficiency (17.9%) among BMES patients. Three BME manuscripts were associated with vitamin C deficiency. Current therapeutic interventions include conservative measures (mainly unloading), various osteoactive drugs and iloprost. In summary, data about BMES in association with vitamin status is limited. A causal relationship between vitamin D or vitamin C status, osteopenia, and BMES cannot be determined from the existing literature.
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Rupp T, von Vopelius E, Strahl A, Oheim R, Barvencik F, Amling M, Rolvien T. Beneficial effects of denosumab on muscle performance in patients with low BMD: a retrospective, propensity score-matched study. Osteoporos Int 2022; 33:2177-2184. [PMID: 35751664 PMCID: PMC9546982 DOI: 10.1007/s00198-022-06470-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/13/2022] [Indexed: 12/13/2022]
Abstract
UNLABELLED This study examined the effects of denosumab compared to bisphosphonates and vitamin D alone on muscle performance in patients with low BMD. While grip force improved in both the denosumab and bisphosphonate group, a superior increase in chair rising test force was observed in the denosumab group. INTRODUCTION The aim of this study was to investigate the effect of the anti-resorptive agent denosumab (Dmab) on upper and lower limb muscle performance compared to bisphosphonate (BP) treatment and vitamin D supplementation alone (i.e., basic therapy) in patients with low BMD. METHODS This retrospective, propensity score-matched (sex, age, BMI, follow-up time) cohort study included 150 osteopenic or osteoporotic patients receiving basic (n = 60), BP (n = 30) or Dmab (n = 60) therapy. All patients underwent a musculoskeletal assessment at baseline and follow-up, including DXA, laboratory bone metabolism parameters, grip force, and chair rising test mechanography. Mean annual percentage changes were calculated and compared between study groups. RESULTS After a mean follow-up period of 17.6 ± 9.0 months, a significantly higher increase in grip force in both the Dmab (p < 0.001) and BP group (p = 0.001) compared to the vitamin D group was observed (vitamin D = - 6.1 ± 10.2%; BP = + 0.8 ± 8.2%; Dmab = + 5.1 ± 25.5%). The Dmab group showed a significantly higher increase in chair rising test force compared to the BP group (vitamin D = + 5.8 ± 12.7%; BP = + 0.9 ± 8.6%; Dmab = + 8.2 ± 14.4%; Dmab vs. BP p = 0.03). Neither the changes in BMD nor in bone metabolic parameters were associated with changes in muscle performance. CONCLUSION Dmab resulted in increased muscle strength in the upper and lower limbs, indicating systemic rather than site-specific effects as compared to BP. Based on these findings, Dmab might be favored over other osteoporosis treatments in patients with low BMD and poor muscle strength.
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Affiliation(s)
- Tobias Rupp
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 59, 20259, Hamburg, Germany
| | - Emil von Vopelius
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 59, 20259, Hamburg, Germany
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - André Strahl
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Ralf Oheim
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 59, 20259, Hamburg, Germany
| | - Florian Barvencik
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 59, 20259, Hamburg, Germany
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestrasse 59, 20259, Hamburg, Germany.
| | - Tim Rolvien
- Department of Trauma and Orthopaedic Surgery, Division of Orthopaedics, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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