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Zoledronic acid may not be a good choice to reduce
cartilage volume loss in knee osteoarthritis with bone marrow lesions.
Twelve-monthly zoledronic acid infusions in patients with
symptomatic knee osteoarthritis (OA) and bone marrow lesions did not
considerably decrease cartilage volume loss over a period of 2 years, as came
forward in the results from a randomized clinical trial published in ‘JAMA’.
Guoqi Cai et al. assessed the effects of zoledronic acid intravenous (IV) on knee cartilage volume loss in symptomatic knee OA patients and with bone marrow lesions.
This was a 24-month, randomized double-blind
placebo-controlled trial conducted in multiple centres and comprised of
patients aged ≥50 years with symptomatic knee OA. The MRI was used to detect
the subchondral bone marrow lesions in patients enrolled from November 2013 to
September 2015. Total of 113 patients was given zoledronic acid IV
with either 5 mg in a 100-mL saline solution and 110 patients were given a
placebo saline solution at baseline and 12 months.
The primary outcome of the study was the change in tibiofemoral cartilage volume over 24 months. The change in knee pain evaluated via visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index over 3, 6, 12, 18, and 24 months and variation in bone marrow lesion size over 6 and 24 months, were the three main predefined secondary outcomes.
Out of 223 participants registered (mean age 62.0 years and 52% being female), 190 completed the trial. The change in tibiofemoral cartilage volume did not significantly vary amongst the zoledronic acid group and the placebo over 24 months. There were no significant between-group differences observed for any of the secondary outcomes. Commonly observed side effect with zoledronic acid mostly comprised of acute reactions (described as symptoms within 3 days of administration of infusion) as compared with placebo.
JAMA
Effect of Intravenous Zoledronic Acid on Tibiofemoral Cartilage Volume Among Patients With Knee Osteoarthritis With Bone Marrow Lesions: A Randomized Clinical Trial
Guoqi Cai et al.
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