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Minerva Medica 2018 August;109(4):300-25

DOI: 10.23736/S0026-4806.18.05688-4


language: English

Clodronate in the management of different musculoskeletal conditions

Bruno FREDIANI 1 , Andrea GIUSTI 2, Gerolamo BIANCHI 3, Luca DALLE CARBONARE 4, Nazzarena MALAVOLTA 5, Luca CANTARINI 1, Gianantonio SAVIOLA 6, Luigi MOLFETTA 7

1 Department of Rheumatology, Osteoporosis and Osteoarticular Instrumental Diagnosis Center, University of Siena, Siena, Italy; 2 Department of Ortho-Geriatrics, Rehabilitation and Stabilization, Frailty Area, Bone Clinic, Galliera Hospital, Genoa, Italy; 3 Division of Rheumatology, Department of Locomotor System, ASL003, Genoa, Italy; 4 Department of Medicine, University of Verona and Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy; 5 Division of Rheumatology, Department of Cardiac Thoracic and Vascular Disease, University of Bologna, Bologna, Italy; 6 Unit of Rheumatology and Rehabilitation, Salvatore Maugeri Foundation IRCCS, Castel Goffredo, Mantua, Italy; 7 Division of Orthopedics and Traumatology, School of Medical and Pharmaceutical Science, DINOGMI Department, Section of Orthopedic Rehabilitation, University of Genoa, Genoa, Italy


INTRODUCTION: Clodronic acid is a non-nitrogen-containing bisphosphonate largely used from some decades in the prevention and treatment of postmenopausal and secondary osteoporosis. In addition to antiresorptive activity, clodronate has shown anti-inflammatory and analgesic properties, and modulatory effects on bone and cartilage metabolism.
EVIDENCE ACQUISITION: A literature review has been conducted to characterize the mechanism of action of clodronate and to retrieve available evidence about the use of clodronate in primary and secondary osteoporosis, and its potential role in other musculoskeletal conditions and orthopedic surgery.
EVIDENCE SYNTHESIS: The efficacy and safety of the available clodronate formulations (oral, intravenous and intramuscular) in the prevention and treatment of postmenopausal and secondary osteoporosis, including corticosteroid-induced osteoporosis and bone mass loss secondary to endocrine, gastrointestinal and neoplastic diseases, have been demonstrated in a variety of clinical trials. The analgesic, anti-inflammatory, bone- and chondro-modulating properties of clodronate have allowed to expand its use in other musculoskeletal conditions to those currently approved. Clodronate has proven to be beneficial in the treatment of osteoarthritis of the knee and of the hand, in the management of complex regional pain syndrome, and in the peri- and postoperative phase in subjects undergoing arthroplasty.
CONCLUSIONS: The analysis of the available literature has shown that clodronate has relevant musculoskeletal effects beyond the antiresorptive activity. Further research is needed to better position clodronate therapy in the management of these conditions and to define the optimal formulation and dose regimen in any of the tested new indications.

KEY WORDS: Clodronic acid - Osteoporosis - Osteoarthritis - Arthroplasty

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