Pamidronate disodium for polyostotic fibrous dysplasia in the proximal femur：twenty-four cases report

XU Ming; XU Song-feng; YU Xiu-chun

doi:10.3969/j.issn.2095-252X.2014.05.013

Abstract：Objective To investigate the therapeutic methods and clinical effects of pamidronate disodium for polyostotic ifbrous dysplasia in the proximal femur in different degrees. Methods From June 2009 to January 2012, 24 patients with polyostotic ifbrous dysplasia in the proximal femur were adopted and treated. There were 14 males and 10 females, whose average age was 24 years old ( range;8-61 years ). A combination of surgery and postoperative pamidronate disodium was performed on 11 patients, curettage, bone graft and internal ifxation on 8 patients, simple internal fixation on 3 patients and only pamidronate disodium on 13 patients. Pamidronate disodium was taken every 3 months after the operation or after the ifrst treatment, and the duration was 2 years. Before the treatment or before pamidronate disodium injection, bone metabolic markers were detected and the imaging examination was performed in all the patients, including osteocalcin ( OC ) and C-terminal telopeptides of type I collagen ( CTX-I ).The Visual Analogue Scale ( VAS ) was used to evaluate the preoperative and postoperative pain. The hip function was systematically assessed based on the Harris hip score. The adverse effects were observed. Results A total of 205 times of pamidronate disodium injection were received. All the patients were followed up for 24-55 months, and the median follow-up time was 42 months. At the 2nd year after the treatment, the level of OC in the serum was ( 80.195±64.75 )μg/L, which was obviously reduced when compared with the level of ( 147.198±104.86 )μg/L before the treatment. The differences between them were statistically signiifcant ( P=0.000 ). At the 2nd year after the treatment, the level of CTX-I in the serum was ( 0.672±0.61 )μg/L, which was also obviously reduced when compared with the level of ( 1.396±0.6 )μg/L before the treatment. The differences between them were statistically signiifcant ( P=0.000 ). In the group of a combination of surgery and postoperative pamidronate disodium, disease progression of fracture again was noticed only in 1 case and ifrm internal ifxation in the other 10 cases, including 7 cases of increased bone mass and 3 cases of no disease progression. In the group of only pamidronate disodium, disease progression was noticed only in 1 case and increased bone mass, reduced osteolysis and cortical thickening of bone in different degrees in the other 12 cases. Pain was gradually relieved after the treatment in all the patients, with excellent VAS scores on average in the latest follow-up. In the group of a combination of surgery and pamidronate disodium, the VAS score was ( 1.33±1.1 ) points in the latest follow-up, which was obviously reduced when compared with the preoperative VAS score of ( 7.25±1.7 ) points. The differences between them were statistically signiifcant ( P=0.002 ). In the group of only pamidronate disodium, the VAS score was ( 1.17±1.5 ) points in the latest follow-up, which was reduced when compared with the preoperative VAS score of ( 5.83±1.3 ) points. The differences between them were statistically signiifcant ( P=0.002 ). The hip function was well restored in all the patients, with good Harris hip scores in the latest follow-up. In the group of a combination of surgery and pamidronate disodium, the Harris hip score was ( 79.58±5.2 ) points in the latest follow-up, which was greater than the preoperative Harris hip score of ( 43.67±31.8 ) points. The differences between them were statistically signiifcant ( P=0.002 ). In the group of only pamidronate disodium, the Harris hip score was ( 79.17±8.4 ) points in the latest follow-up, which was greater than the preoperative Harris hip score of ( 69.75±7.9 ) points. The differences between them were statistically signiifcant ( P=0.002 ). Except that fever was noticed in 5 patients at the 2nd day after the ifrst intravenous drip infusion of pamidronate disodium, no adverse reactions were found in the 24 patients. Conclusions Pamidronate disodium is effective in the treatment of polyostotic fibrous dysplasia in the proximal femur, with the advantages of inhibiting osteolytic bone destruction, preventing the risk of bone fractures, relieving pain, improving the hip function, reducing adverse reactions and minimizing the treatment time. For the patients with asymptomatic polyostotic fibrous dysplasia or McCune-Albright syndrome, surgery is unnecessary and pamidronate disodium is a good choice. Curettage, bone graft and internal ifxation should be performed on the patients with limited extent of lesions and osteolytic bone destruction. Simple internal ifxation should be performed on the patients with extensive lesions in the proximal femur, pathological fractures or severe deformities or on the verge of fractures. Both kinds of patients above should receive pamidronate disodium injection after the operation, so as to prevent bone absorption and disease progression.