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"I'm finding it shocking and surprising the number of new people joining the community. Let me explain. I was diagnosed with AVN first in both knees back in 2005, over the next few years it was found in both hips and shoulders. I had never come across AVN before and felt like I was the only person with it, I was always having to explain to people what it was."
 
"Thankfully I found this website and community over a year ago and realised I was not the only one suffering with AVN, it has been such a help talking to fellow sufferers who understand what I am going through."
 
Text taken from a recent post in our community forum.

Join us

If you are suffering from avascular necrosis AVN Osteonecrosis ON, or are close to someone that is, please consider joining our AVN Charity UK community. You will find many shared experiences about AVN and how it affects each of us differently, importantly there are also excellent success stories about the road to "Pain Free".
 
We also welcome any health professionals who are involved in any way with Avascular Necrosis AVN, please let us know how you think you can help.

New treatment trials for AVN

Article written by charity trustee Jon Murnaghan.
 
It is difficult to organise large scale trials of new treatments for AVN because it is an uncommon condition and finding enough patients to include in a trial, ideally you would want hundreds or even thousands, is impossible. So most research is done on small groups of tens of patients, usually without a control group who would receive a standard recognised treatment for comparison with the new treatment being tested. Because of this testing a new treatment and getting it accepted as being better than an existing treatment is slow.
 
These treatments are being used, and they do have promising results from small trials, however they haven't been proved to be more effective than the currently accepted treatments such as core decompression. Some also have their own risks of side effects like Biphosphonate-related Osteonecrosis of the Jaw (BRONJ).
 
I have included links to research articles. In some cases only the abstract or summary of the article can be read without payment.
 

Biphosphonates

The biphosphonates are a group of drugs that affect bone remodelling, the process in which bone cells are constantly resorbed and new bone cells laid down. They block the action of osteoclast cells which are responsible for bone resorption. Biphosphonates are now commonly prescribed for the treatment of osteoporosis and they are also used in the treatment of bone tumours.
 
There are ten types of biphosphonate each having different strengths including clodronate (bonefos) and alendronate (fosamax). There have been a small number of trials using biphosphonates to treat AVN of the hip which have shown that people taking biphosphonates are less likely to suffer damage to the joint and to require surgery. Whilst the results are promising these trials were very small with only a few tens of subjects. They also used different criteria for entry to the trial and different biphosphonates were given in different ways and with different dosages which makes comparisons between the trials impossible. The trials only lasted for a maximum of two years. In contrast the biggest trial of biphosphonates for the treatment of osteoporosis had 50,000 participants and lasted initially for ten years. That trial is continuing to follow the participants for a further ten years.
 
The commonest side effect of biphosphonates taken as pills for osteoporosis is irritation of the stomach.
 

BRONJ side effect

A serious, paradoxical but rare side effect of biphosphonate use is Biphosphonate-Related Osteonecrosis of the Jaw (BRONJ). This usually only occurs in people receiving high dose intravenous biphosphonate injections for bone cancers, and is often associated with a dental operation. If taking biphosphonates it is important to inform your dentist and to take extra care with dental hygiene.

Biphosphonates stay in the body for years and their long term effects are still unknown.

 

References:

1. Cardozo JB, Andrade DM, Santiago MB. The use of bisphosphonate in the treatment of avascular necrosis: a systematic review. Clin Rheumatol. 2008 Jun;27(6):685-8. doi: 10.1007/s10067-008-0861-9. Epub 2008 Feb 13. Review. PubMed PMID: 18270760.
2. Lozano-Calderon SA, Colman MW, Raskin KA, Hornicek FJ, Gebhardt M. Use of bisphosphonates in orthopedic surgery: pearls and pitfalls.Orthop Clin North Am. 2014 Jul;45(3):403-16. doi: 10.1016/j.ocl.2014.03.006. Review. PubMed PMID
3. Goytia RN, Salama A, Khanuja HS. Bisphosphonates and osteonecrosis: potential treatment or serious complication? Orthop Clin North Am. 2009 Apr;40(2):223-34. doi: 10.1016/j.ocl.2008.12.002. Review. PubMed PMID: 19358907.
4. Teitelbaum SL, Seton MP, Saag KG. Should bisphosphonates be used for long-term treatment of glucocorticoid-induced osteoporosis? Arthritis Rheum. 2011 Feb;63(2):325-8. doi: 10.1002/art.30135. PubMed PMID: 21279986; PubMed Central PMCID: PMC3069536.

Last Updated on Thursday, 01 January 2015 20:45