[Pharmacological therapy for subchondral pathologies of the knee joint].

Abstract

Background: Pathologies of the subchondral bone include both structural alterations such as osteonecrosis and bone marrow edema. Both entities are amenable to pharmacological therapy.

Objective: Presentation of current recommendations for drug therapy of osteonecrosis and bone marrow edema of the knee joint based on the clinical data.

Methods: The currently available literature is evaluated and discussed.

Results: Antiresorptives such as bisphosphonates and denosumab and the osteoanabolic agent teriparatide therapeutically address the locally diminished bone density potentially resulting in insufficiency fractures. In contrast, vitamin K antagonists, heparin and new/direct oral anticoagulants, as well as iloprost exert their effects at the vascular and hemostatic level. All drug treatment concepts are "off-label" use. They are particularly promising in the early stages of primary, idiopathic osteonecrosis and bone marrow edema.

Conclusion: In osteonecrosis and bone marrow edema of the knee joint, complementary drug therapy may be beneficial. However, the available data is not yet sufficiently robust for general treatment recommendations.