Short-term bisphosphonate therapy could ameliorate osteonecrosis: a complication in childhood hematologic malignancies

Abstract

Osteonecrosis (ON) is a critical complication in the treatment of childhood leukemia and lymphoma. It particularly affects survivors of acute lymphoblastic leukemia and non-Hodgkin lymphoma reflecting the cumulative exposure to glucocorticosteroid therapy. ON is often multiarticular and bilateral, specially affecting weight-bearing joints. A conventional approach suggests a surgical intervention even if pharmacological options have also recently been investigated. We reported two cases of long time steroid-treated patients who underwent Bone Marrow Transplantation (BMT) for hematological disease. Both patients developed femoral head osteonecrosis (ON) that was diagnosed by magnetic resonance imaging (MRI) and the ON was also accompanied with pain and a limp. Despite of the conventional strategies of therapy, we successfully started a short-term treatment with bisphosphonates in order to decrease the pain and the risk of fracture.

Figure 1

Moderate bilateral joint effusion and fat-like aspects of osteonecrosis involving the weight bearing portion of the femoral heads. In the left hip where the articular surface is partially flattened. Bone marrow oedema is also present bilaterally, around the femoral capital necrosis.

Figure 2

Bilateral joint effusion and bone marrow oedema are disappeared. The right femoral head shows a regular articular surface but with aspects of midollary sclerosis. Partial aspect of fragmentation on the left femoral capital necrosis.

Figure 3

Flattened right femoral head, joint effusion, enlarged physes, bone marrow oedema of the femoral neck, and minimal sclerotic changes of the articular surface. There is a remarkable increase of the signal on T₁W sequences only in the deep portion of the femoral head.

Figure 4

Boundary line of the necrosis of the capital of the femur with a fat-like aspect, good remodelling of the femoral head, and morphologic normalization of the physes are shown in this follow up MRI.