| Etidronate |
| Banavac et al., 1993 |
Inclusion: No specific inclusion criteria listed. Patients with SCI admitted to the rehabilitation center 2–6 weeks post injury. There were 2 females and 25 males, ranging in age from 16 to 54 years, who were either paraplegics or tetraplegics.
Exclusion: Not specified.
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Prospective control trial - 27 patients participated.
300mg etidronate disodium was administered IV over a 3-hour period daily for 3–5 days. After parenteral therapy, 20 mg of etidronate was administered orally for 6 months.
11 controls received oral etidronate alone for 6 months. |
Observed swelling. |
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After initial IV therapy, 20 patients showed prompt reduction in swelling over initial 48 hrs, while 7 patients had no change or an increase in swelling.
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Overall, treatment reduced swelling (p<0.01).
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No significant differences noted between those who had received both IV and oral etidronate and those who had received oral etidronate alone, with respect to effect on HO.
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| Garland 1983 |
Inclusion: Spinal cord injured patients with clinical signs of HO. Mean age = 25y; Gender: males = 9; Level of injury: cervical = 6, thoracic =5; Severity of injury: complete = 7, incomplete = 2; Etiology of injury: diving accident = 3, motor vehicle accident = 1, gunshot wound = 1, motorcycle accident = 1, hand-gliding accident = 1.
Exclusion: Not specified.
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Case series - 14 patients participated.
Once HO was diagnosed in patients, bisphosphonate therapy was administered at a dosage of 20mg/kg/day for two weeks and then at a dosage of 10mg/kg/day for 2 years. |
Effectiveness of treatment, adverse effects |
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Pre-treatment 8/9 patients had HO in 10 hips. The 9th patient had a positive bone scan but no radiographic evidence of HO.
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Post treatment all patients showed evidence of HO.
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Post-treatment of the 9 minimal graded hips only 1 stayed at the minimal grad while others increased (5 mild, 3 moderate, 5 severe).
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No adverse effects were seen.
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| Subbarao et al., 1987 |
Inclusion: Specific inclusion criteria not listed; however, participants were between the ages of 34 and 41years, and were 77 to 197 months post injury; duration of follow-up ranged from 8 to 35 months.
Exclusion: Not specified.
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Case Series - etidronate (20mg/kg body weight) was given 10–14 days preoperatively; medication was withheld for a postoperative period of 72 hours, but then continued (10mg/kg body weight) for a minimum of 3 months. All 5 patients underwent wedge resection at hip to permit free movement of hip in flexion. |
Not specified. |
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At last follow-up, all patients were able to function independently in their wheelchairs, except for one who functioned independently in a semi-reclining wheelchair.
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Patients had severe restriction of ROM in involved joints.
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| Banavoc et al., 1997 |
Inclusion: Not explicitly stated. A likely diagnosis of HO based upon clinical signs and symptoms and positive bone scintigraphy in SCI patients. Those who participated were admitted to the rehabilitation centre 2 to 5 weeks post injury, and ranged in age from 16 to 55 years. Two were female and 44 were male. 24 patients were paraplegic and 22 were tetraplegic.
Exclusion: Not specified.
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Prospective control trial - 46 patients participated.
3 hrs of IV disodium etidronate on day of HO diagnosis, continued for 3 successive days, followed by etidronate X6 mos. |
Degree of HO was determined radiographically: Grade 1 = minimal, Grade 2 = mild, Grade 3 = moderate, Grade 4 = severe, Grade 5 = ankylosis. |
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Group 1 (positive bone scan and negative X-ray for HO, n=33), 5 patients discontinued therapy and showed gradual development of HO. Of the remaining 28 patients, 22 had no X-ray evidence of HO, while 6 had developed an X-ray diagnosis of HO at follow-up.
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Group 2 (positive bone scan and X-ray, n=13). Progression of soft tissue ossification was inhibited by etidronate in 1 of 6 patients, while the remaining 7 did not respond to treatment, with progression of HO.
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| Banovac 2000 |
Inclusion: No specific inclusion criteria listed; however, participants had been admitted to the rehab center 2 to 5 weeks post injury. 39 males and 1 females; mean age 23 years. 18 with tetraplegia and 22 paraplegia.
Exclusion: Not specified.
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Case series - 40 patients with positive clinical findings and positive nuclear bone scan were treated with IV etidronate sodium, followed by 20mg/kg/day given orally for 6mos. |
Not specified. |
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11/40 (28%) SCI patients developed radiographic evidence of HO from 1.5 to 6yrs post treatment.
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95% of cases of recurrent HO developed in different areas, involving different joints.
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| Pamidronate |
| Schuetz et al., 2005 |
Inclusion: No specific inclusion criteria stated; however, all were male and between the ages of 47 and 68 years.
Exclusion: Not specified.
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Case study - 5 patients underwent excision-surgery for removal of HO.
Pamidronate administered IV peri- and post-op, starting at 120 mg for 1st 12 hrs, gradually increasing dose over a total of 6–14 days. |
Not specified. |
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None of the patients treated with pamidronate exhibited clinical, X-ray or lab signs of HO recurrence or new HO at time of follow-up, 5–54 months post-op.
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