Zoledronic acid may not reduce cartilage volume loss with knee OA, bone marrow lesions
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Yearly zoledronic acid infusions did not significantly reduce cartilage volume loss in 24 months among patients with symptomatic knee osteoarthritis and bone marrow lesions compared with placebo, according to published results.
Graeme Jones, PhD, and colleagues randomly assigned 223 patients with symptomatic knee OA and subchondral bone marrow lesions detected by MRI to receive a single 15-minute IV infusion of either 5 mg of zoledronic acid in a 100 mL saline solution (n=113 patients) or a placebo saline solution (n=110 patients) at baseline and 12 months. Researchers assessed the absolute change in tibiofemoral cartilage volume for 24 months using MRI as the primary outcome, while change in knee pain assessed by VAS and WOMAC index during 3, 6, 12, 18 and 24 months and change in bone marrow lesion size during 6 and 24 months were considered secondary outcomes.
Among the 190 patients who completed the trial, results showed no significantly different changes in tibiofemoral cartilage volume in 24 months between the zoledronic acid and placebo groups. Researchers also found no significant between-group differences in changes in knee pain as assessed by VAS and WOMAC index or in changes in bone marrow lesion size in 24 months. According to results, 96% of patients in the zoledronic acid group experienced adverse events vs. 83% in the placebo group. Researchers noted the adverse events consisted mainly of acute reactions, defined as symptoms within 3 days of administration of infusion.
“Despite some initial promising data, this large trial makes it very clear that antiresorptive therapy does not influence the symptoms or course of osteoarthritis of the knee, even in those with bone marrow lesions,” Jones told Healio Orthopedics. – by Casey Tingle
Disclosures: Jones reports he was a recipient of a National Health and Medical Research Council of Australia practitioner fellowship and receives personal fees for serving as a consultant to multiple unnamed pharmaceutical companies. Please see the study for all other authors’ relevant financial disclosures.
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