title: Intravenous bisphosphonates and vitamin D in the treatment of bone marrow oedema in professional athletes.
abstract: BACKGROUND
  The goal of this retrospective study was to evaluate the safety and efficacy of ibandronate for bone marrow oedema (BMO) syndrome and stress fracture cases, and to demonstrate an additional field of therapeutic importance-the high-performance athlete.
  
  
  METHODS
  This retrospective study included twenty-five high-performance athletes. Sixty per cent of the athletes were European soccer players and 40.0% other high-class international athletes (3 women and 22 men with an average age of 25.0±4.2), with BMO of the lower trunk or extremity diagnosed by magnetic resonance imaging (MRI). The treatment regimen consisted of high-dose vitamin D supplementation and intravenous ibandronate therapy.
  
  
  RESULTS
  The time between the onset of pain and proper diagnosis of BMO was 106.3±104.1 days. Excellent pain reduction (pain at rest and under strain) and improved mobility was reported within the first two weeks after the first ibandronate administration by sixteen patients (64%). The time from first treatment until return to competition (RTC) was on average 102.6±65.2 days in total. If the time from onset of pain until diagnosis was within 40 days, the RTC was significantly reduced (p≤0.05) to almost 50% (63.8±48.1 days) when compared to the athletes with later diagnosis (124.4±63.2 days).
  
  
  CONCLUSIONS
  The here-applied therapy regimen of intravenous BPs application and vitamin D supplementation in BMO syndrome has a beneficial effect for high-performance athletes. An early diagnosis and rapid treatment start can reduce the RTC significantly. An optimal bone metabolism with sufficient daily calcium and vitamin D intake is crucial and should not only be strived for the professional but also for the recreational athlete.
authors.affiliation: Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Electronic address: ma.simon@uke.de.
authors.forename: Maciej J K
authors.initials: MJ
authors.lastname: Simon
authors.affiliation: Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Electronic address: fbarvencik@uke.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Barvencik
authors.affiliation: Private Practice for Radiology and Nuclear Medicine, Burgstrasse 7, 80331 Munich, Germany. Electronic address: g.luttke@radiologie-muenchen.de.
authors.forename: Moritz
authors.initials: M
authors.lastname: Luttke
authors.affiliation: Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany. Electronic address: amling@uke.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Amling
authors.affiliation: MW Center for Orthopedics and Sports Medicine, Munich and Football Club FC Bayern Munich, Dienerstrasse 12, 80331 Munich, Germany. Electronic address: info@mw-oc.de.
authors.forename: Hans-Wilhelm
authors.initials: HW
authors.lastname: Mueller-Wohlfahrt
authors.affiliation: Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany; MW Center for Orthopedics and Sports Medicine, Munich and Football Club FC Bayern Munich, Dienerstrasse 12, 80331 Munich, Germany. Electronic address: peter.ueblacker@gmx.net.
authors.forename: Peter
authors.initials: P
authors.lastname: Ueblacker
mesh_terms: D000328:Adult; D056352:Athletes; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001855:Bone Marrow Diseases / Q000188:drug therapy / Q000473:pathology*; D004164:Diphosphonates / Q000627:therapeutic use*; D004487:Edema / Q000188:drug therapy / Q000473:pathology*; D005260:Female; D015775:Fractures, Stress / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D000077557:Ibandronic Acid; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D013577:Syndrome; D016896:Treatment Outcome; D014807:Vitamin D / Q000627:therapeutic use*
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D014807:Vitamin D; D000077557:Ibandronic Acid
keywords: Bisphosphonate treatment; Bone marrow oedema; High-performance athlete; Stress fracture; Vitamin D