Bisphosphonate Treatment in Chronic Recurrent Multifocal Osteomyelitis

Objective

To test the safety and efficacy of biphosphonates in chronic recurrent multifocal osteomyelitis (CRMO).

Study design

Five patients with CRMO, all of whom had ongoing pain and loss of function despite conventional treatment with non-steroidal anti-inflammatory agents, were treated with pamidronate (1 mg/kg/dose with a dosing frequency of 2 to 4 monthly for a total treatment duration of 12 to 42 months).

Results

Pain decreased after the first infusion for 4 of 5 patients, with symptomatic improvement maintained with time. Significant improvement was seen in radiological lesions for these 4 patients.

Conclusion

Bisphosphonates appear to be a useful and safe adjunctive treatment in CRMO when simple therapies such as anti-inflammatory agents fail to control symptoms or cases in which lesion expansion continues.

Abbreviations: CNO, Chronic non-bacterial osteomyelitis, CRMO, Chronic recurrent multifocal osteomyelitis, NSAID, Non-steroidal anti-inflammatory agent, SAPHO syndrome, Synovitis, acne, pustulosis, hyperostosis, and osteitis