Do Bisphosphonates Benefit Patients With Knee Osteoarthritis?

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Bisphosphonates may still benefit patients who display high rates of subchondral bone turnover.

For patients with knee osteoarthritis, bisphosphonates neither provide symptomatic relief nor defer radiographic progression, according to data presented at the 2017 ACR/ARHP Annual Meeting.

Previous studies have suggested that bisphosphonates may be effective for osteoarthritis based on their ability to “limit excessive bone remodeling and block osteoclast-mediated pain pathways”, however major methodological flaws may have led to misleading conclusions.  

For this study, the researchers searched multiple databases for randomized controlled trials that included knee osteoarthritis patients who were treated with bisphosphonates and where validated pain and function scales, radiographic progression and adverse events were reported. Seven studies were included in the analysis (n=3013) with most patients receiving oral risedronate, as well as concomitant nonsteroidal anti-inflammatory drugs (NSAIDs). 

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“No pain or function outcomes, regardless of dose, route, time point or measuring instrument, revealed statistically significant results,” said the authors, “Similarly, we found no statistically significant effect on radiographic progression.” 

However, the authors noted, for patients who show high rates of subchondral bone turnover, these agents may still be beneficial. “Future studies should be directed at defining such [osteoarthritis] subsets and investigating the effects of bisphosphonates in those patients,” the authors concluded.

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