Evidence for using bisphosphonate to treat Legg-Calvé-Perthes disease hip

Megan L. Young, David G. Little, Harry K W Kim

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background: The rationale for using bisphosphonate (BP) therapy for Legg-Calvé-Perthes disease (LCPD) is the potential to prevent substantial femoral head deformity during the fragmentation phase by inhibiting osteoclastic bone resorption. However, it is unclear whether BP therapy decreases femoral head deformity. Questions/purposes: In this systematic review, we answered the following questions: (1) Does bisphosphonate (BP) therapy decrease femoral head deformity and improve pain and function in LCPD or other juvenile osteonecrotic conditions? And (2) does BP therapy decrease femoral head deformity in experimental studies of juvenile femoral head osteonecrosis? Methods: We searched the literature from 1966 to 2011 for clinical and experimental studies on BP therapy for juvenile femoral head osteonecrosis. Studies specifically addressing clinical and/or radiographic/histologic outcomes pertaining to pain and function and femoral head morphology were analyzed. Results: Three Level IV clinical studies met our inclusion criteria. Only one study initiated BP therapy during the precollapsed stage of osteonecrosis and reported prevention of femoral head deformity in nine of 17 patients. All studies noted subjective improvements of pain and gait in patients treated with intravenous BPs. Of the eight experimental studies reviewed, seven reported reduced femoral head deformity and six found better preservation of trabecular framework in animals treated with BPs. Conclusions: Clinical evidence lacks consistent patient groups and drug protocols to draw definitive conclusions that BP therapy can decrease femoral head deformity in juvenile osteonecrotic conditions. Experimental studies suggest BP therapy protects the infarcted femoral head from deformity, but it lacks bone anabolic effect. Further basic and clinical research are required to determine the potential role of BPs as a medical treatment for LCPD.

Original languageEnglish (US)
Pages (from-to)2462-2475
Number of pages14
JournalClinical Orthopaedics and Related Research
Volume470
Issue number9
DOIs
StatePublished - Sep 2012

Fingerprint

Legg-Calve-Perthes Disease
Diphosphonates
Hip
Osteonecrosis
Thigh
Therapeutics
Pain
Anabolic Agents
Coxa Magna
Bone Resorption
Gait
Bone and Bones

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Evidence for using bisphosphonate to treat Legg-Calvé-Perthes disease hip. / Young, Megan L.; Little, David G.; Kim, Harry K W.

In: Clinical Orthopaedics and Related Research, Vol. 470, No. 9, 09.2012, p. 2462-2475.

Research output: Contribution to journalArticle

@article{e5fa36c780b548eabef97ed2023d5d5f,
title = "Evidence for using bisphosphonate to treat Legg-Calv{\'e}-Perthes disease hip",
abstract = "Background: The rationale for using bisphosphonate (BP) therapy for Legg-Calv{\'e}-Perthes disease (LCPD) is the potential to prevent substantial femoral head deformity during the fragmentation phase by inhibiting osteoclastic bone resorption. However, it is unclear whether BP therapy decreases femoral head deformity. Questions/purposes: In this systematic review, we answered the following questions: (1) Does bisphosphonate (BP) therapy decrease femoral head deformity and improve pain and function in LCPD or other juvenile osteonecrotic conditions? And (2) does BP therapy decrease femoral head deformity in experimental studies of juvenile femoral head osteonecrosis? Methods: We searched the literature from 1966 to 2011 for clinical and experimental studies on BP therapy for juvenile femoral head osteonecrosis. Studies specifically addressing clinical and/or radiographic/histologic outcomes pertaining to pain and function and femoral head morphology were analyzed. Results: Three Level IV clinical studies met our inclusion criteria. Only one study initiated BP therapy during the precollapsed stage of osteonecrosis and reported prevention of femoral head deformity in nine of 17 patients. All studies noted subjective improvements of pain and gait in patients treated with intravenous BPs. Of the eight experimental studies reviewed, seven reported reduced femoral head deformity and six found better preservation of trabecular framework in animals treated with BPs. Conclusions: Clinical evidence lacks consistent patient groups and drug protocols to draw definitive conclusions that BP therapy can decrease femoral head deformity in juvenile osteonecrotic conditions. Experimental studies suggest BP therapy protects the infarcted femoral head from deformity, but it lacks bone anabolic effect. Further basic and clinical research are required to determine the potential role of BPs as a medical treatment for LCPD.",
author = "Young, {Megan L.} and Little, {David G.} and Kim, {Harry K W}",
year = "2012",
month = "9",
doi = "10.1007/s11999-011-2240-0",
language = "English (US)",
volume = "470",
pages = "2462--2475",
journal = "Clinical Orthopaedics and Related Research",
issn = "0009-921X",
publisher = "Springer New York",
number = "9",

}

TY - JOUR

T1 - Evidence for using bisphosphonate to treat Legg-Calvé-Perthes disease hip

AU - Young, Megan L.

AU - Little, David G.

AU - Kim, Harry K W

PY - 2012/9

Y1 - 2012/9

N2 - Background: The rationale for using bisphosphonate (BP) therapy for Legg-Calvé-Perthes disease (LCPD) is the potential to prevent substantial femoral head deformity during the fragmentation phase by inhibiting osteoclastic bone resorption. However, it is unclear whether BP therapy decreases femoral head deformity. Questions/purposes: In this systematic review, we answered the following questions: (1) Does bisphosphonate (BP) therapy decrease femoral head deformity and improve pain and function in LCPD or other juvenile osteonecrotic conditions? And (2) does BP therapy decrease femoral head deformity in experimental studies of juvenile femoral head osteonecrosis? Methods: We searched the literature from 1966 to 2011 for clinical and experimental studies on BP therapy for juvenile femoral head osteonecrosis. Studies specifically addressing clinical and/or radiographic/histologic outcomes pertaining to pain and function and femoral head morphology were analyzed. Results: Three Level IV clinical studies met our inclusion criteria. Only one study initiated BP therapy during the precollapsed stage of osteonecrosis and reported prevention of femoral head deformity in nine of 17 patients. All studies noted subjective improvements of pain and gait in patients treated with intravenous BPs. Of the eight experimental studies reviewed, seven reported reduced femoral head deformity and six found better preservation of trabecular framework in animals treated with BPs. Conclusions: Clinical evidence lacks consistent patient groups and drug protocols to draw definitive conclusions that BP therapy can decrease femoral head deformity in juvenile osteonecrotic conditions. Experimental studies suggest BP therapy protects the infarcted femoral head from deformity, but it lacks bone anabolic effect. Further basic and clinical research are required to determine the potential role of BPs as a medical treatment for LCPD.

AB - Background: The rationale for using bisphosphonate (BP) therapy for Legg-Calvé-Perthes disease (LCPD) is the potential to prevent substantial femoral head deformity during the fragmentation phase by inhibiting osteoclastic bone resorption. However, it is unclear whether BP therapy decreases femoral head deformity. Questions/purposes: In this systematic review, we answered the following questions: (1) Does bisphosphonate (BP) therapy decrease femoral head deformity and improve pain and function in LCPD or other juvenile osteonecrotic conditions? And (2) does BP therapy decrease femoral head deformity in experimental studies of juvenile femoral head osteonecrosis? Methods: We searched the literature from 1966 to 2011 for clinical and experimental studies on BP therapy for juvenile femoral head osteonecrosis. Studies specifically addressing clinical and/or radiographic/histologic outcomes pertaining to pain and function and femoral head morphology were analyzed. Results: Three Level IV clinical studies met our inclusion criteria. Only one study initiated BP therapy during the precollapsed stage of osteonecrosis and reported prevention of femoral head deformity in nine of 17 patients. All studies noted subjective improvements of pain and gait in patients treated with intravenous BPs. Of the eight experimental studies reviewed, seven reported reduced femoral head deformity and six found better preservation of trabecular framework in animals treated with BPs. Conclusions: Clinical evidence lacks consistent patient groups and drug protocols to draw definitive conclusions that BP therapy can decrease femoral head deformity in juvenile osteonecrotic conditions. Experimental studies suggest BP therapy protects the infarcted femoral head from deformity, but it lacks bone anabolic effect. Further basic and clinical research are required to determine the potential role of BPs as a medical treatment for LCPD.

UR - http://www.scopus.com/inward/record.url?scp=84866362670&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866362670&partnerID=8YFLogxK

U2 - 10.1007/s11999-011-2240-0

DO - 10.1007/s11999-011-2240-0

M3 - Article

C2 - 22270467

AN - SCOPUS:84866362670

VL - 470

SP - 2462

EP - 2475

JO - Clinical Orthopaedics and Related Research

JF - Clinical Orthopaedics and Related Research

SN - 0009-921X

IS - 9

ER -