Bisphosphonates in osteoid osteoma with difficult location in children - 02/10/26

Doi : 10.1016/j.otsr.2026.104911

Océane Mignon ^a, Rose Elisabeth Jeantet ^b, Marion Delpont ^c, Damien Fron ^d, Valérie Bousson ^e, Romain Lecigne ^f, François Robin ^g,^h, Philippe Violas ^b,^i,⁎

^a Orthopedic Surgery Department, Rennes University Hospital, Rennes, France

^b Pediatric Orthopedic Surgery Department, Rennes University Hospital, Rennes, France

^c Pediatric Orthopedic Surgery Department, University of Montpellier, Montpellier, France

^d Pediatric Orthopedic Surgery, Department Lille University Hospital, Lille, France

^e Radiology Department, Hôpital Lariboisière, Assitance Publique–Hôpitaux de Paris, Nord-Université Paris Cité, 2 rue Ambroise-Paré, 75010 Paris, France

^f Radiology Department, Rennes University Hospital, Rennes, France

^g Univ Rennes, INSERM, Inrae, CHU Rennes, UMR 1317, UMR 1341, Institut NuMeCan (Nutrition, Metabolisms and Cancer), Rennes, France

^h Rheumatology Department, Rennes University Hospital, Rennes, France

ⁱ Univ Rennes, INSERM LTSI, UMR 1099, MediCis, Rennes, France

^⁎ Corresponding author at: Pediatric Orthopedic Surgery Department, Rennes University Hospital, Rennes, France. Pediatric Orthopedic Surgery Department Rennes University Hospital Rennes France

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 02 October 2026

Abstract

Introduction

Osteoid osteoma is a benign bone tumor that may cause severe pain. Although percutaneous thermoablation is commonly performed and effective in approximately 90% of cases by rapidly relieving symptoms and avoiding surgery, this procedure may carry significant risks when lesions are located near sensitive anatomical structures such as neural, medullary, or cartilaginous tissues. In these situations, bisphosphonates (BP) may represent a less invasive therapeutic alternative by biologically reducing abnormal bone activity and inflammatory pain. Previous studies have demonstrated the efficacy of zoledronic acid in osteoid osteoma, but pediatric data remain scarce.

Hypothesis

Bisphosphonates may represent an alternative therapeutic option for osteoid osteomas located in anatomically challenging areas unsuitable for conventional treatments.

Material and methods

This multicenter retrospective study included 11 pediatric patients with osteoid osteoma located close to neural or cartilaginous structures contraindicating surgical treatment or thermoablation and treated with bisphosphonates. Patients received 3–6 monthly infusions of zoledronic acid. Clinical pain assessment, NSAID and analgesic consumption, imaging outcomes, and treatment-related adverse events were collected before and after treatment.

Results

Eleven patients (3 girls and 8 boys) were included between 2012 and 2024. Mean age was 13.5 years (range, 8–17 years). Mean baseline Visual Analog Scale (VAS) score was 70.6/100 (30–90). NSAID and analgesic consumption was reported in 91% of patients, while all patients presented with a visible nidus and reactive bone marrow edema on imaging. Mean duration of symptoms before BP treatment was 12.7 months (2–26). The mean number of infusions was 3.8 (3–6). Only one patient developed anterior uveitis, which did not require treatment discontinuation. At final follow-up, mean VAS score decreased to 30.4/100 (0–80), while NSAID and analgesic consumption decreased to 36%. Complete disappearance of both nidus and bone marrow edema was observed in 73% of patients. Mean follow-up duration was 7.2 months.

Conclusion

Zoledronic acid appears to be a promising therapeutic alternative for osteoid osteomas located in anatomically challenging areas in children. Its efficacy is reflected by nidus disappearance, pain reduction, and decreased NSAID consumption. Further studies with larger cohorts and longer follow-up are required to strengthen the level of evidence.