Texas Scottish Rite Hospital for Children, UT Southwestern Medical Center, Dallas, TX, USA.
Clin Orthop Relat Res. 2012 Sep;470(9):2462-75. doi: 10.1007/s11999-011-2240-0.
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?
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.
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.
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.
使用双膦酸盐 (BP) 治疗 Legg-Calvé-Perthes 病 (LCPD) 的基本原理是通过抑制破骨细胞的骨吸收，在碎裂期预防股骨头显著变形。然而，BP 治疗是否能减少股骨头变形尚不清楚。
问题/目的：在这项系统评价中，我们回答了以下问题：(1) 在 LCPD 或其他青少年骨坏死性疾病中，双膦酸盐 (BP) 治疗是否能减少股骨头变形，改善疼痛和功能？(2) 在青少年股骨头坏死的实验研究中，BP 治疗是否能减少股骨头变形？
我们从 1966 年至 2011 年检索了关于 BP 治疗青少年股骨头坏死的临床和实验研究文献。分析了专门针对与疼痛和功能及股骨头形态相关的临床和/或影像学/组织学结果的临床和实验研究。
符合纳入标准的有 3 项 IV 级临床研究。只有一项研究在骨坏死的预塌陷期开始 BP 治疗，并报告在 17 例患者中有 9 例预防了股骨头变形。所有研究均指出，接受静脉注射 BP 治疗的患者的疼痛和步态均有主观改善。所审查的 8 项实验研究中，有 7 项报告股骨头变形减少，6 项发现 BP 治疗的动物中骨小梁框架保存更好。
临床证据缺乏一致的患者群体和药物方案，无法得出 BP 治疗可减少青少年骨坏死性疾病中股骨头变形的确切结论。实验研究表明 BP 治疗可防止梗死股骨头变形，但缺乏骨合成代谢作用。需要进一步的基础和临床研究来确定 BP 作为 LCPD 治疗药物的潜在作用。
