Nitrogen-containing bisphosphonates for burn-related heterotopic ossification

• Main Authors: Sarthak Sinha, Jeff A. Biernaskie, Duncan Nickerson, Vincent A. Gabriel
• Format: Article
• Language: English
• Published: Elsevier 2018-07-01
• Series: Burns Open
• Online Access: http://www.sciencedirect.com/science/article/pii/S2468912217300603

Introduction: Heterotopic ossification (HO) is a rare but debilitating complication of burn injuries. Previous studies reported non-nitrogen containing bisphosphonates such as etidronate for burn-related HO not to be useful. Waiting till HO maturity before surgical resection may lead to an extended period of disability. This case series reviews one centers’ use of nitrogen-containing bisphosphonates as an adjunct treatment to surgical intervention for burn-related HO. Methods: A one-year retrospective review of patients at an American Burn Association verified burn center with burns and heterotopic ossification treated with nitrogen-containing bisphosphonate was undertaken. Records were examined for injury characteristics, investigations, outcomes of treatment, and adverse events. Results: Heterotopic ossification treated with nitrogen-containing bisphosphonates were identified in five subjects. Four subjects were treated with Pamidronate and one subject was treated with Alendronate. HO was removed without recurrence in one subject, and in the other four, HO was brought to maturity quickly and early resection was planned. No adverse events such as osteonecrosis of the jaw was reported in the patients reviewed. Discussion: Nitrogen-containing bisphosphonates may have an adjunctive role in the surgical treatment of burn-related HO. Specifically, they may be useful for hastening maturity of burn-related HO. It is not known if peri-operative dosing may be useful around the time of surgical resection. These drugs have been used in the ICU, acute care, and outpatient settings at a tertiary burn center without complications. Keywords: Burns, Heterotopic ossification, Bisphosphonate, Etidronate, Pamidronate, Alendronate, Rehabilitation