Treatment of refractory symphysitis pubis with intravenous pamidronate

Osteitis pubis is a noninfectious painful inflammatory disorder of the symp hysis pubis. Etiologic factors include urologic procedures, abdomino-perine al and gynecological surgery, and spondyloarthropathies, although many case s are idiopathic. Most respond to conservative measures consisting primaril y of rest and analgesic/antiinflammatory agents. We describe 3 cases, 2 wit h idiopathic osteitis pubis and one that was associated with a spondyloarth ropathy, that failed to respond to conservative measures but experienced cl inical remission with 3 to 6 monthly courses of intravenous pamidronate, Re mission was also evident in 2 patients on isotope bone scan. Followup has r evealed no recurrence. Intravenous pamidronate may constitute a safe and ef fective treatment option for patients with refractory osteitis pubis.