Bisphosphonate treatment for patients with chronic nonbacterial osteomyelitis

Abstract

Chronic recurrent multifocal osteomyelitis (CRMO) is a severe form of chronic nonbacterial osteomyelitis (CNO) that affects the long bones as well as other skeletal sites, such as the spine. Gleeson et al. recently described seven patients affected by CRMO who were treated with intravenous pamidronate, and concluded that pamidronate therapy should be considered early in the treatment of CRMO affecting the spine. No nonvertebral effects of pamidronate were noted, indicating that additional anti-inflammatory medication should be used in patients who have vertebral and nonvertebral CNO lesions. Although adverse effects of bisphosphonate therapy on bone have been noted previously, Gleeson et al. only reported undesirable effects such as generalized aches and pains, fever and injection-site reaction. As with previous studies of bisphosphonate treatment of patients with CNO, however, the number of patients included in this study was small (n = 7) and the follow-up was limited; therefore, bisphosphonate treatment of children and adolescents should only be considered as a last resort until controlled trials with long-term follow-up are performed.