Treatment of osteitis pubis with pamidronate in athletes

Abstract Objective To describe the effectiveness of intravenous pamidronate in the treatment of resistant osteitis pubis (OP) in athletes. Methods Eight consecutive high-level amateur athletes attending a Sport and Exercise Medicine clinic with refractory OP and bone marrow oedema (BME) of the symphysis pubis on magnetic resonance imaging (MRI) were treated with intravenous pamidronate infusions. Patients above 60 kg in weight received 60 mg intravenous pamidronate and those below 60 kg received 30 mg. Patients were offered a second dose after a 3-month interval if symptoms had not improved sufficiently. Primary outcome measure was return to sport. Secondary outcome measures were pain scores on a 0–10 scale and a rating of overall improvement pre- and post-infusion. Results Mean symptom duration was 19 months. Five patients rated themselves as ‘significantly improved’ and one had ‘some improvement’. All five patients who reported a ‘significant improvement’ returned to sport. Pain scores improved: (1) at rest (1.07 to 0.29, P = 0.10); (2) during activities of daily living (4.3 to 1.2, P = 0.004); and (3) during sport (8.1 to 1.2, P = 0.001). Discussion This study provides objective evidence to support the use of pamidronate to treat refractory OP with associated BME.