The Role of Bisphosphonates and Prostaglandins for the Treatment of Subchondral Insufficiency Fractures of the Knee: An Evidenced-Based Opinion

Zachary S Aman, Nicholas N. DePhillipo, D. R. Lind, T. Dekker, R. LaPrade
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Abstract

Subchondral Insufficiency Fractures of the Knee (SIFK) can result in accelerated cartilage degeneration and poor outcomes. The presence of SIFK is difficult to manage and can cause persistent knee swelling, pain, and prolonged disability. Pharmacologic agents to suppress extensive bone remodeling, improve blood supply, and reduce pain have been suggested as treatment for these lesions. Nonoperative management with prostaglandins and bisphosphonates has emerged as a potentially efficacious intervention for symptom reduction and resolution of knee bone marrow edema. However, previous reports of potential serious adverse effects including atypical femoral fractures of the proximal femur raise concerns for clinical safety. This evidence-based opinion article demonstrates the potential clinical efficacy of various pharmacologic therapies, including prostaglandins and bisphosphonates, for the treatment of SIFK. The overall rate of reporting adverse effects in the literature is high (47.3%), while significant clinical improvements have been identified in 66% to 100% of the patient population. This collective information may help guide physicians during prescription drug therapy for the treatment of SIFK.
双膦酸盐和前列腺素治疗膝关节软骨下不全骨折的作用:基于证据的观点
膝关节软骨下不全性骨折(SIFK)可导致加速软骨退变和不良预后。SIFK的存在很难控制,并可引起持续的膝关节肿胀、疼痛和长期残疾。抑制广泛骨重塑、改善血液供应和减轻疼痛的药物制剂已被建议作为这些病变的治疗方法。前列腺素和双膦酸盐的非手术治疗已成为减轻症状和解决膝关节骨髓水肿的潜在有效干预措施。然而,先前报道的潜在严重不良反应,包括股骨近端非典型股骨骨折,引起了对临床安全性的关注。这篇基于证据的观点文章展示了各种药物治疗的潜在临床疗效,包括前列腺素和双膦酸盐,用于治疗SIFK。文献中报告不良反应的总体比率很高(47.3%),而66%至100%的患者群体均有显著的临床改善。这些集体信息可以帮助指导医生在治疗SIFK的处方药治疗过程中。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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