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An open-label, prospective, observational study of the efficacy of bisphosphonate therapy for painful osteoid osteoma

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To assess the efficacy of bisphosphonate therapy on bone pain in patients with osteoid osteoma (OO) (main objective), and to describe bisphosphonate-induced changes in nidus mineralisation and regional bone-marrow oedema (BMO).

Methods

A prospective, observational study was conducted from 2011 to 2014. Patients with risk factors for complications of percutaneous or surgical ablation or recurrence after ablation, were offered once monthly intravenous bisphosphonate treatment until significant pain alleviation was achieved.

Results

We included 23 patients. The first two patients received pamidronate and the next 21 zoledronic acid (mean, 2.95 infusions per patient). Bisphosphonate therapy was successful in 19 patients (83%), whose mean pain visual analogue scale score decreased by 76.7%; this pain-relieving effect persisted in 17 patients (74%) with a mean follow-up time of 36 months. Computed tomography (CT) demonstrated a mean nidus density increase of 177.7% (p = 0.001). By magnetic resonance imaging (MRI), mean decreases were 38.4% for BMO surface area and 30.3% for signal intensity (p = 0.001 and p = 0.000, respectively).

Conclusions

In 17/23 patients with painful OO managed conservatively with bisphosphonates, long-term final success was achieved. Bisphosphonates may accelerate the spontaneous healing of OO.

Key points

• 19/23 patients with OO managed with bisphosphonates experienced significant pain relief

• Pain relief was sustained in 17/23 patients, mean follow-up of 36 months

• CT demonstrated a significant increase in nidus mineralisation

• MRI demonstrated a significant decrease in bone marrow oedema

• Bisphosphonate therapy may accelerate the spontaneous healing of OO

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Abbreviations

BMO:

bone-marrow oedema

BMO Ar:

BMO surface area

BMO In:

mean BMO signal intensity

BM Ref:

mean signal intensity in a region of interest of normal bone marrow

NID Ar AX :

nidus area in the axial plane

NID Ar Long :

nidus area in the longitudinal plane

NID Ar Mean :

mean nidus area

NID Dens:

mean CT density within the nidus area

NSAIDs:

non-steroidal anti-inflammatory drugs

OO:

osteoid osteoma

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Acknowledgements

We thank all the patients and investigators for their participation, the staff members who participated in patient inclusion, and Ms. Olivia Tran for phone calls to patients.

Author information

Authors and Affiliations

  1. Service de Radiologie Ostéo-Articulaire, AP-HP, Hôpital Lariboisière, 2 rue Ambroise Paré, 75010, Paris, France

    Valérie Bousson, Bassam Hamzé, Caroline Parlier-Cuau & Jean-Denis Laredo

  2. Sorbonne Paris Cité, Université Paris Diderot, 75205, Paris, France

    Valérie Bousson, Tifenn Leturcq, Hang-Korng Ea, Caroline Parlier-Cuau, Jean-Denis Laredo & Philippe Orcel

  3. Service de Rhumatologie, AP-HP, Hôpital Lariboisière, 2 rue Ambroise Paré, 75010, Paris, France

    Tifenn Leturcq, Hang-Korng Ea & Philippe Orcel

  4. Service d’Imagerie Diagnostique et Thérapeutique de l’adulte, CHU Pellegrin Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France

    Olivier Hauger

  5. Service de Rhumatologie, CHU Pellegrin Bordeaux, Place Amélie Raba Léon, 33076, Bordeaux, France

    Nadia Mehsen-Cetre & Thierry Schaeverbeke

Authors
  1. Valérie Bousson
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  2. Tifenn Leturcq
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  3. Hang-Korng Ea
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  4. Olivier Hauger
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  5. Nadia Mehsen-Cetre
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  6. Bassam Hamzé
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  7. Caroline Parlier-Cuau
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  8. Jean-Denis Laredo
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  9. Thierry Schaeverbeke
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  10. Philippe Orcel
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Corresponding author

Correspondence to Valérie Bousson.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Prof. Philippe Orcel.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Funding

The authors state that this work has not received any funding.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

The study is currently registered on a WHO-compliant registry. In addition we are starting a multicentre randomised trial comparing percutaneous ablation to bisphosphonate therapy (the ongoing observational study and the randomised trial are registered at ClinicalTrials.gov; ID, NTC02739555).

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Dynamic contrast-enhanced MR imaging in osteoid osteoma: relationships with clinical and CT characteristics. Pottecher P, Sibileau E, Aho S, Hamze B, Parlier C, Laredo JD, Bousson V. Skeletal Radiol. 2017 Jul;46(7):935-948. doi: 10.1007/s00256-017-2645-2. Epub 2017 Apr 11. PMID: 28401265 and Is pain duration associated with morphologic changes of osteoid osteomas at CT? Touraine S, Emerich L, Bisseret D, Genah I, Parlier-Cuau C, Hamze B, Petrover D, Laredo JD, Bousson V. Radiology. 2014 Jun;271(3):795-804. doi: 10.1148/radiol.14131629. Epub 2014 Feb 1. PMID: 24495266

Methodology

• prospective

• observational

• multicentre study (two centres)

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Bousson, V., Leturcq, T., Ea, HK. et al. An open-label, prospective, observational study of the efficacy of bisphosphonate therapy for painful osteoid osteoma. Eur Radiol 28, 478–486 (2018). https://doi.org/10.1007/s00330-017-5019-1

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  • DOI: https://doi.org/10.1007/s00330-017-5019-1

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