Bisphosphonates

The evidence for nonsteroidal anti-inflammatory drugs (NSAIDs) as prophylactic treatment for heterotopic ossification (HO) comes mostly from the use of indomethacin or ibuprofen as HO prophylaxis in patients following total hip arthroplasty (THA; Kjaersgaard-Andersen & Schmidt 1986; Ritter & Sieber 1985). Although it has been reported that the prophylactic use of these medications significantly decreases HO formation following THA, it is not known if they have the same effect in the post ABI population.

Ethylhydroxybisphosphonate (EHDP)

The use of Etidronate (EHDP; a bisphosphate) in the prophylaxis and treatment of HO is controversial (Watanabe & Sant 2001). EHDP works by preventing the aggregation, growth and mineralization of calcium hydroxyapatite crystals which are essential for bone formation. EHDP may potentially delay fracture healing, as long-term use has been associated with osteomalacia.

Table: Effects of Ethylhydroxybisphosphonate in the Treatment of Heterotopic Ossification

Discussion

Although EHDP has been shown to be effective in reducing HO in other populations, such as SCI, its effectiveness among individuals with brain injury is less studied. In an ABI population, Spielman et al. (1983) did find that patients treated with EHDP showed a significantly lower incidence of HO than the control group. However, due to the small sample size of the study and the research design, additional research assessing the benefit of EHDP for the treatment of HO following brain injury is needed.

Conclusion

There is Level 2 evidence that Disodium Etidronate reduces the development of heterotopic ossification in patients with severe head injury. 

 

Etidronate prevents the development of heterotopic ossification.