Examining the Effectiveness of Bisphosphonates for Knee Osteoarthritis

Bisphosphonates provide no significant benefit over placebo in patients with knee osteoarthritis (OA) with regard to pain relief, functional improvement, or prevention of radiographic progression, according to a meta-analysis published in Osteoarthritis and Cartilage.¹

Although prior meta-analyses indicated that bisphosphonates may have a positive effect on the symptomatology of OA, researchers at Tufts Medical Center in Boston, Massachusetts, found that these studies had major methodologic flaws.^2,3

Therefore, they sought to provide data on the efficacy of bisphosphonates in a more homogenous population of people with knee OA using well-validated study outcomes and a placebo comparator.¹

Using various literature databases, these researchers identified randomized controlled trials (RCTs) comparing any bisphosphonate with placebo in patients with knee OA and found 7 RCTs that were eligible for analysis. These trials included 3013 patients, most of whom had mild-to-moderate knee OA; 2767 of these patients received oral risedronate. 

The analysis demonstrated no statistically significant difference between bisphosphonates and placebo on radiographic progression of disease or in pain or function outcomes regardless of dose, route, time point, or measuring instrument. In addition, there was no statistically significant difference between bisphosphonates and placebo with regard to serious adverse events or withdrawal from treatment because of adverse events.    

The study authors suggest that the lack of efficacy of bisphosphonates in treating the symptoms of knee OA are the result of the changing balance of bone-resorptive and bone-formative processes within subchondral bone over the course of the disease.¹ 

They concluded, “[O]ur analysis showed that bisphosphonates neither provide symptomatic relief nor defer radiographic progression in patients with knee OA. Future RCTs should be directed at defining subsets of [patients with] OA who display high rates of subchondral bone turnover and investigating the effects of bisphosphonates in those patients.”

References

1. 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 December 5, 2017] Osteoarthritis Cartilage. doi:10.1016/j.joca.2017.11.013
2. Davis AJ, Smith TO, Hing CB, Sofat N. Are bisphosphonates effective in the treatment of osteoarthritis pain? A meta-analysis and systematic review. PLoS One. 2013;8(9):e72714.
3. Xing RL, Zhao LR, Wang PM. Bisphosphonates therapy for osteoarthritis: a meta-analysis of randomized controlled trials. Springerplus. 2016;5(1):1704.

This article originally appeared on Rheumatology Advisor