Pharmacological interventions on nontraumatic osteonecrosis
| Treatment . | Indication . | Study cohort . | Dose . | Study design . | ON classification . | Follow-up . | Conclusions . | Reference . |
|---|---|---|---|---|---|---|---|---|
| LMW heparin | ||||||||
| LMW heparin | ON and thrombophilia and/or hypofibrinolysis | No full text | Enoxaparin 60 mg/d for 12 wk | n.s. | Ficat | n.s. | May prevent progression | 29 |
| Prostacyclin analog | ||||||||
| Iloprost | BME/AVN of any etiology including leukemia | 50 pts (11-76 y) | 0, 5-1, 0 ng/kg/min 5 d (6 h) | Single center | ARCO | 6 mo | In BME and early AVN: significant improvement in pain, functional, and radiological outcome stages | 31 |
| Statins | ||||||||
| Statin | high dose GCS | 284 pts (27-71 y) | ≥1 statins | n.s. | MRI ON verifying | 5-11 y | Protection against osteoporosis and osteonecrosis | 35 |
| Lovastatin | Steroid treated rabbits | 54 rabbits (28-32 wk) | Lovastatin 5 mg/kg/d | Laboratory | Histopathology | 12 wk after steroids | Prevention of development of steroid-induced ON in rabbits by inhibiting adipogenesis | 47 |
| Bisphosphonate | ||||||||
| Alendronate | ALL/NHL | 10 pts (3, 6-14, 6 y) | Alendronate 30-70 mg/week, calcium daily over 6 mo | n.s. | Osteopenia monitoring | 6 mo | Accretion of bone mineral | 42 |
| Alendronate | ON after BMT (ALCL/ALL relapse) | 2 pts (10-12 y) | 5-10 mg/d po for 11-12 mo | Case report | None | 6, 5-7 y | Pain reduction, improvement motor function, MRI improvement, densitometry improvement | 38 |
| Pamidronate/alendronate | ALL (16 HR) | 17 pts (5-16 y) | 6 pts (later 3 pts) alendronate 70 mg/week | Single center | Volume affected 0 to >200 cm3 | 0-21 mo | Pamidronate: pain reduction Improvement motor function of affected joints | 37 |
| 3 pts (later 6 pts) pamidronate 16, 8-65 mg/m2 | ||||||||
| Pamidronate | ALL (SR/HR) | 17 pts (2, 9-19, 4 y) | 14 pts pamidronate (dose unknown) | Single center | Articular surface affected <15% to >50% | 6-72 mo | Pain reduction, improvement motor function | 40 |
| Zoledronic acid | ALL/AML/NHL/HL/ benign hematologic disorder | 20 pts (7, 8-14, 5 y) | Number of doses 2-8; 5-25 mo | n.s. | ARCO | 24 mo | Controlling pain, slowed process of progressive joint destruction in knee joints | 39 |
| Treatment . | Indication . | Study cohort . | Dose . | Study design . | ON classification . | Follow-up . | Conclusions . | Reference . |
|---|---|---|---|---|---|---|---|---|
| LMW heparin | ||||||||
| LMW heparin | ON and thrombophilia and/or hypofibrinolysis | No full text | Enoxaparin 60 mg/d for 12 wk | n.s. | Ficat | n.s. | May prevent progression | 29 |
| Prostacyclin analog | ||||||||
| Iloprost | BME/AVN of any etiology including leukemia | 50 pts (11-76 y) | 0, 5-1, 0 ng/kg/min 5 d (6 h) | Single center | ARCO | 6 mo | In BME and early AVN: significant improvement in pain, functional, and radiological outcome stages | 31 |
| Statins | ||||||||
| Statin | high dose GCS | 284 pts (27-71 y) | ≥1 statins | n.s. | MRI ON verifying | 5-11 y | Protection against osteoporosis and osteonecrosis | 35 |
| Lovastatin | Steroid treated rabbits | 54 rabbits (28-32 wk) | Lovastatin 5 mg/kg/d | Laboratory | Histopathology | 12 wk after steroids | Prevention of development of steroid-induced ON in rabbits by inhibiting adipogenesis | 47 |
| Bisphosphonate | ||||||||
| Alendronate | ALL/NHL | 10 pts (3, 6-14, 6 y) | Alendronate 30-70 mg/week, calcium daily over 6 mo | n.s. | Osteopenia monitoring | 6 mo | Accretion of bone mineral | 42 |
| Alendronate | ON after BMT (ALCL/ALL relapse) | 2 pts (10-12 y) | 5-10 mg/d po for 11-12 mo | Case report | None | 6, 5-7 y | Pain reduction, improvement motor function, MRI improvement, densitometry improvement | 38 |
| Pamidronate/alendronate | ALL (16 HR) | 17 pts (5-16 y) | 6 pts (later 3 pts) alendronate 70 mg/week | Single center | Volume affected 0 to >200 cm3 | 0-21 mo | Pamidronate: pain reduction Improvement motor function of affected joints | 37 |
| 3 pts (later 6 pts) pamidronate 16, 8-65 mg/m2 | ||||||||
| Pamidronate | ALL (SR/HR) | 17 pts (2, 9-19, 4 y) | 14 pts pamidronate (dose unknown) | Single center | Articular surface affected <15% to >50% | 6-72 mo | Pain reduction, improvement motor function | 40 |
| Zoledronic acid | ALL/AML/NHL/HL/ benign hematologic disorder | 20 pts (7, 8-14, 5 y) | Number of doses 2-8; 5-25 mo | n.s. | ARCO | 24 mo | Controlling pain, slowed process of progressive joint destruction in knee joints | 39 |
ACTH, adrenocorticotropic hormone; ALCL, anaplastic large cell lymphoma; AML, acute myeloid leukemia; ARCO, association research circulation osseous; AVN, avascular necrosis; BME, bone marrow edema; BMT, bone marrow transplantation; GCS, glucocorticosteroids; HL, Hodgkin lymphoma; HR, high risk; LMW, low molecular weight; NHL, non-Hodgkin lymphoma; n.s., not specified; ON, osteonecrosis; po, by mouth; pts, patients; SR, standard risk.