Clinical, Bone Mineral Density and Spinal Remodelling Responses to Zoledronate Treatment in Chronic Recurrent Multifocal Osteomyelitis
Abstract
Background: Chronic Recurrent Multifocal Osteomyelitis (CRMO) is a rare auto-inflammatory condition affecting the growing skeleton. The standard first-line treatment of high-dose NSAIDs (non-steroidal anti-inflammatory drugs) is adequate only in a subset of patients. The American College of Rheumatology Consensus Guidelines suggest considering bisphosphonates in a certain category of patients based on evidence from a handful of case series reporting the outcome of pamidronate use. Aims: The aim of this study was to report the efficacy and safety of bisphosphonate, predominantly zoledronate, use in CRMO. Methods: A retrospective cohort study of children with CRMO receiving bisphosphonates was conducted between January 2008 and September 2023 at a single tertiary referral centre. We described the baseline characteristics; clinical indication, regimen and response to bisphosphonate treatment; changes in bone mineral density (BMD) and spine remodelling on dual-energy X-ray absorptiometry (DXA) scans; and safety data. Results: During the study period, 64 (72%, n = 46 females) patients with CRMO with a median age at diagnosis of 10 years (range: 3 to 16 years) were identified. Approximately 31% (n = 20) received either pamidronate (n = 2) or zoledronate (n = 14) or both (n = 4) due to changes in local protocols. The most frequent indications for bisphosphonate use were refractory pain [55%, n = 11/20], pain + spine involvement [35% (n = 7/20)] and spine involvement only [10% (n =…
How strong is the evidence?
Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health. Reported size: 46 participants or records.
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