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Both systemic and intra-articular steroids have also
been used without significant reduction in illness dura-
tion.
3
Deflazacort, a bone-sparing steroid, adminis-
tered to two patients at a dose of 60 mg PO for 1 week
and tapered over 1 month was reportedly effective in
eliminating symptoms with complete recovery in 2-4
weeks.
28
However, there are no other reports of gluco-
corticoid treatment in TMO and their prolonged use
would be contraindicated in OI.
treatment studies reported to date. There are no reports
of the use of Rank ligand inhibitors (denusomab,
Amgen) in TMO treatment. However, the bone anabolic
agent teriparatide has been used successfully in one
62-year-old male.
29
The fact that different bone active
agents, acting through different mechanisms, have
salutary effects on shortening the duration of pain and
disability in transient osteoporosis requires critical eval-
uation. The positive responses to these different medi-
cations (both antiresorptive and anabolic) fail to resolve
the question as to the etiology of the bone edema syn-
drome in OI. Also,
Table 39.2
indicates that the major-
ity of clinical reports involve only one or two patients:
larger treatment series are required.
Antiresorptive Agents
Both calcitonin and bisphosphonates of different
formulations have been used with reported success in
transient osteoporosis.
Table 39.2
lists details of the
TABLE 39.2
The Effects of Anti-Resorptive and Anabolic Treatment on the Duration of Transient Osteoporosis of the Hip
Number of
Patients
Authors/Year
Treatment
Dose
Route
Duration
Outcome Measures
Arayssi et al.
[3]
2
Calcitonin
Resolution of symptoms
in 6-9 weeks
pregnancy and postpartum
Laktasic-Zeriavic
[33]
Calcitonin
8 weeks
Full resolution of symptoms in
pregnancy
Varenna et al.
[7,17]
3
Clodronate
30 mg/day
IV
10 consecutive days
Complete recovery of femoral
density within 4 months
Varenna et al.
[13]
16
Pamidronate
45 mg/d
IV
3 infusions, once every
third day
One month after the infusion
course, both VAS and FUI scores
were significantly lower
(P <0.00001). After 2 months,
all patients were asymptomatic.
After 3 months, all MRI had
normalized
La Montagna
et al.
[18]
1
Neridronate
25 mg/month
IM
6 months
After 3 weeks, the patient
reported progressive
improvement. After 2 months,
patient became asymptomatic
Ringe et al.
[15]
12
Ibandronate
4 mg/day
IV
a second single dose
Rapid and substantial pain relief
2 mg dose optional after 4 weeks
Samdani et al.
[2]
1
Alendronate
10 mg/day
PO
after 3 months
Within days, the bone pain
began to dissipate
Schapira et al.
[14]
1
Clodronate
300 mg/day
IV
for 10 days; after 2
months a second
course for 5 days was
administered
Within 2 weeks, the pain
decreased. Two months
after beginning, she was
asymptomatic
Miltner et al.
[3]
1
Alendronate
70 mg weekly
PO
12 weeks
Reduction of symptoms within
2 weeks MRI had normalized
after 12 weeks normal
Seok et al.
[32]
1
Zoledronic
Acid
5 mg
IV
single infusion
Recovery from pain in 2 weeks
Fabbriciani et al.
[29]
1
Teriparatide
20 μg/d
SC
4 weeks
Symptoms cleared MRI
normalized
(Modified after Kibbi L
36
)
FUI: functional impairment score, range 0-100; VAS: visual analog scale, range 0-100; IV: intravenous; PO: oral; IM: intramuscular.
