The efficacy and safety of bisphosphonates in patients with bone marrow edema syndrome/transient osteoporosis: A systematic literature review.

BACKGROUND

The purpose of our systematic literature review study was to critically analyze all current data including time to achieve pain relief and resolution of bone marrow edema (BME) on magnetic resonance imaging (MRI) in patients with bone marrow edema syndrome (BMES) when using bisphosphonates.

METHODS

A systematic review was performed to address studies which concerned the efficacy and safety of bisphosphonates in patients with BMES. A systematic search was conducted by two investigators using databases including Pubmed and Scopus.

RESULTS

Nine studies were included between July 2002 and June 2019 with a total of 187 patients out of whom 150 had been treated with bisphosphonates. Mean age of patients was 44,14 (mean ranges 34.9-54.0), 113 males and 54 females (excluding one study which did not mention ages). Five studies described the outcomes from MRI on follow-up (42 out of 78 patients achieved resolution with time ranging from 3 to 12 months with a mean of 3.85 months) and eight studies described the outcomes regarding pain resolution (128 out of 140 achieved resolution with mean time 4.20 months, ranging from 0.7 months to 12 months). Adverse events related to the administration of bisphosphonates included flue-like symptoms in 6 patients, musculoskeletal pain in 1 patient, arthralgias and fever in 9 patients.

CONCLUSIONS

The outcome of this systematic review indicated that the effect of bisphosphonates on pain relief and on regression of BME on MRI is controversial, but due to the low level of evidence of the included studies, no definite conclusions can be acquired and no evidence based recommendation could be given.