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Alendronate Offers Promising Treatment for Transient Osteoporosis
A DGReview of :"Transient osteoporosis of the navicular bone in a runner"
Archives of Orthopaedic and Trauma Surgery
11/20/2003
By Mary Beth Nierengarten
Treatment with alendronate may permit athletes with transient osteoporosis to return earlier to high-level activities, reports a German study.
Treatment of transient osteoporosis, which is considered a self-limited disorder, is controversial with some clinicians preferring core decompression and others preferring conservative management that includes treatment of symptoms and avoidance of weight-bearing. Use of the bisphosphonate, alendronate, has only been described in one previous article, which reported a benefit to reducing symptoms and fracture risk. Since bisphosphonates inhibit bone resorption, which is linked to increased bone mineral density and reducing fracture risk, as well as reduce pain in osteolytic metastases and multiple myeloma, it is thought that these agents can treat transient osteoporosis by inhibiting inflammation and reducing pain.
In this study, O Miltner, MD, and colleagues, Orthopaedic Department of the UK Aachen, report on the use of alendronate in an unusual case of transient osteoporosis of the navicular bone of the foot in a 20-year-old female sprinter. Only 2 other cases of transient osteoporosis of the navicular bone have been reported, with most disorders usually occurring in the proximal femur.
In this case study, transient osteoporosis of the navicular bone was diagnosed by magnetic resonance imaging (MRI) after the patient's presenting symptoms of increasing pain upon weight-bearing and discomfort during rest didn't resolve with 8 days of treatment with stabilising dressing, crutches, and non-steroidal analgesics. Additional palliative treatment that included avoidance of weight-bearing and administration of calcium and vitamin D also failed to alleviate the patient's pain. Alendronate (70 mg) once a week for 12 weeks was then included as part of the overall management. After 2 weeks on alendronate, the patient reported reduced symptoms and after 9 weeks after original diagnosis, she was able to begin fitness activities. After 12 weeks of alendronate therapy, a follow-up MRI showed a complete resolution of her condition. No treatment-related side effects were reported.
Arch Orthop Trauma Surg 2003;123:505-508.
"Transient osteoporosis of the navicular bone in a runner"
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