Contrary to prior research, a recent meta-analysis showed that bisphosphonates neither provide symptomatic relief nor defer radiographic progression in knee osteoarthritis (OA). However, these agents may still be beneficial in certain subsets of patients who display high rates of subchondral bone turnover. Researchers searched the literature from inception until August 2017. They included only randomized controlled trials (RCTs) comparing any bisphosphonates vs placebo in knee OA patients and reporting validated pain and function scales, radiographic progression, and adverse events (AEs) outcomes. 7 RCTs (3,013 patients, 69% female) were included; most patients (n= 2,767) received an oral bisphosphonate. They found:
- No pain or function outcomes, regardless of dose, route, time point or measuring instrument, revealed statistically significant results (end of trial pain SMD=−0.16).
- Similarly, there was no statistically significant effect on radiographic progression (risk ratio=0.98).
- 1 small RCT in patients with bone marrow lesions (BMLs) suggested a reduction in BML size at 6 months.
- Bisphosphonates displayed good tolerability, with no statistically significant differences in AE outcomes vs placebo.
Vaysbrot EE, Osani MC, Musetti M-C, McAlindon TE, Bannuru RR. Are bisphosphonates efficacious in knee osteoarthritis? A meta-analysis of randomized controlled trials. [Published online ahead of print December 5, 2017]. Osteoarthritis Cartilage. doi:10.1016/j.joca.2017.11.013.
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