INTRAVENOUS DISODIUM ETIDRONATE THERAPY IN SPINAL-CORD INJURY PATIENTS WITH HETEROTOPIC OSSIFICATION

The goal of the present study was to use intravenous etidronate in the acute phase of heterotopic ossification (HO) in an attempt to achieve a high initial drug concentration at the site of the active ectopic o ssification. The study included 27 consecutive patients with an acute onset of HO after spinal cord injury (SCI). The three-phase bone scan was used to confirm clinical diagnosis of HO. Disodium etidronate (Did ronel) 300 mg was administered intravenously daily for 3 to 5 days. In 20 patients there was a rapid (1-2 days) decrease of soft tissue swel ling (p < 0.01) with no side effects associated with the intravenous a dministration. In seven patients there was minimal or no improvement o f edema after intravenous etidronate. In these patients deep vein thro mbosis was found in the affected limbs. The effect of high dose etidro nate on HO was determined in the group of 13 patients with positive cl inical and scintigraphic finding of an acute HO, but negative radiogra phic studies. After intravenous administration of etidronate for 3 day s (300 mg/day) the drug was continued orally with 20 mg/kg/day for 6 m onths. A placebo was not used in this study. In eight patients there w as no radiographic evidence of HO after therapy while two patients had minimal ossifications. In three patients therapy was interrupted and all developed HO in 1-2 months.