Head
of Orthopedic and Traumatologic Department
Garcia de Orta Hospital, Almada - Portugal
Any comment, suggestion or contact can be done to: nuno.lopes@netvisao.pt
CLINICAL CASE PRESENTATION
1st case of treatment of Perthes disease with a osteogenic modelator: Strontium Ranelate (2007)
After
knowledge of the experimental works of Little (Trans Orthop Res Soc.
2004;29:151) and Kim (Bone Miner Res. 2003;18:2016-22) on the effect of the
bisphosphonates in the modulation of osteogenic reply after bone necrosis, we
have begun the pharmacologic treatment of Perthes disease with another
osteogenic modulator, Strontium Ranelate.
Bisphosphonates (BPP)
has a blocking effect on the osteoclasts, leading to a slowing of the
reabsortive action over de sequetrum after a bone necrosis. The Strontium
Ranelate (ER) acts differently: It have simultaneously a blocking effect over
the osteoclasts, promoting at the same time the proliferation of the
pre-osteoblasts and the synthesis of collagen, essential constituent of bone
matrix. On the other hand the ER is better
tolerated by the child and it does not have secondary effect.
After a visit to the
laboratory and contact with team of investigators that developed the drug in
France, we have been convinced of its low toxicity and adequacy for use in
children. We initiated in January 2007 its use as osteogenic modulator in
Perthes disease.
We present the first
case where it was used: a 6 years-old female child, who presented signals of
hip at risk (collapse Herring C type, with external subluxation and hinged hip).
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We observed that, with
the ER treatment, the fragmentation stage does not appear. The disease
progresses directly from necrotic stage to reconstruction. Without fragmentation,
the femoral head keeps its mechanical resistance and collapse is avoided or is
less probable. On the other hand, the association of a early drilling procedure
before treatment with ER as we use to do, promotes a fast revascularization of
the necrotic zone and leads to a faster evolution of the illness to
reconstruction.
If joint distraction is
needed, then time with fixator is much shorter.
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The
result in this first case of treatment with Strontium Ranelate was very
promising, stimulating us to continue it with its application.
