Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Heterotopic Ossification Medication

  • Author: John Speed, MBBS; Chief Editor: Consuelo T Lorenzo, MD  more...
 
Updated: Apr 02, 2015
 

Medication Summary

Today, the medical treatment of HO is directed at early HO. In the later stages of the development of mature bone, medical treatment is ineffective. Etidronate (Didronel) is the only available medication for the treatment of HO after SCI.[19, 34] Treatment with NSAIDs may be required initially, until the resolution of inflammation and the normalization of CRP levels.[4]

Next

Nonsteroidal anti-inflammatory agents

Class Summary

Presumed to have direct and indirect effects on the formation of HO. Direct effect refers to the inhibition of the differentiation of mesenchymal cells into osteogenic cells, and indirect effect refers to the inhibition of posttraumatic bone remodeling by suppression of the prostaglandin-mediated inflammatory response.

Indomethacin (Indocin)

 

Known to inhibit synthesis of prostaglandins.

Previous
Next

Bisphosphonates

Class Summary

The bisphosphonate group of compounds has properties similar to naturally occurring pyrophosphate, which may be a regulator of calcification.[2] Etidronate disodium is the most extensively studied of this class of drugs for the treatment of HO. Etidronate acts by (1) inhibiting precipitation of calcium phosphate from unsaturated solutions, (2) delaying aggregation of apatite crystals into layers, and (3) blocking conversion of calcium phosphate into hydroxyapatite. Apparently, predisposition to the inflammatory process and mineralization decreases with time, although it is not understood why. This phenomenon may be why there is no massive rebound bone formation after cessation of etidronate. Thus, the effectiveness of etidronate depends entirely on when and how long it is given, and the drug does not affect HO that has already formed.

Etidronate disodium (Didronel)

 

Reduces bone formation and does not alter renal tubular reabsorption of calcium. The effects of etidronate increase as the dose increases. Agent does not appear to affect fracture healing.

Previous
 
 
Contributor Information and Disclosures
Author

John Speed, MBBS Professor (Clinical), Division of Physical Medicine & Rehabilitation, Adjunct Associate Professor, Department of Physical Therapy, Adjunct Professor, NursingDirector, Traumatic Brain Injury Rehabilitation, Medical Director, Inpatient Rehabilitation Unit, University of Utah School of Medicine

John Speed, MBBS is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Pain Society, Association of Academic Physiatrists, International Association for the Study of Pain, International Society of Physical and Rehabilitation Medicine, Utah Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Patrick M Foye, MD Director of Coccyx Pain Center, Professor and Interim Chair of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, University Hospital

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, International Spine Intervention Society, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD Medical Director, Senior Products, Central North Region, Humana, Inc

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Additional Contributors

Robert L Sheridan, MD Assistant Chief of Staff, Chief of Burn Surgery, Shriners Burns Hospital; Associate Professor of Surgery, Department of Surgery, Division of Trauma and Burns, Massachusetts General Hospital and Harvard Medical School

Robert L Sheridan, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American College of Surgeons

Disclosure: Received research grant from: Shriners Hospitals for Children; Physical Sciences Inc<br/>Received income in an amount equal to or greater than $250 from: SimQuest Inc -- consultant on burn mapping softwear ($1,500).

Acknowledgements

Kresimir Banovac, MD, PhD Professor, Departments of Rehabilitation Medicine and Medicine, Associate Vice Chairman, Department of Rehabilitation Science, University of Miami Miller School of Medicine; Medical Director, Spinal Cord Injury Rehabilitation Unit, Jackson Memorial Medical Center

Kresimir Banovac, MD, PhD is a member of the following medical societies: American Spinal Injury Association

Disclosure: Nothing to disclose.

References
  1. Kaplan FS, Xu M, Glaser DL, et al. Early diagnosis of fibrodysplasia ossificans progressiva. Pediatrics. 2008 May. 121(5):e1295-300. [Medline].

  2. Shafer DM, Bay C, Caruso DM, et al. The use of eidronate disodium in the prevention of heterotopic ossification in burn patients. Burns. 2008 May. 34(3):355-60. [Medline].

  3. Peterson JR, De La Rosa S, Sun H, Eboda O, Cilwa KE, Donneys A, et al. Burn Injury Enhances Bone Formation in Heterotopic Ossification Model. Ann Surg. 2013 May 12. [Medline].

  4. Subbarao JV, Garrison SJ. Heterotopic ossification: diagnosis and management, current concepts and controversies. J Spinal Cord Med. 1999 Winter. 22(4):273-83. [Medline].

  5. Pathophysiology of heterotopic ossification. Orthop Nurs. 2013 May-Jun. 32(3):178-9. [Medline].

  6. Zychowicz ME. Pathophysiology of heterotopic ossification. Orthop Nurs. 2013 May-Jun. 32(3):173-7. [Medline].

  7. Rossier AB, Bussat P, Infante F, et al. Current facts of para-osteo-arthropathy (POA). Paraplegia. 1973 May. 11(1):38-78. [Medline].

  8. Wilson KW, Dickens JF, Heckert R, Tintle SM, Keeling JJ, Andersen RC, et al. Heterotopic ossification resection after open periarticular combat-related elbow fractures. J Surg Orthop Adv. 2013 Spring. 22(1):30-5. [Medline].

  9. Bodley R, Jamous A, Short D. Ultrasound in the early diagnosis of heterotopic ossification in patients with spinal injuries. Paraplegia. 1993 Aug. 31(8):500-6. [Medline].

  10. Snoecx M, De Muynck M, Van Laere M. Association between muscle trauma and heterotopic ossification in spinal cord injured patients: reflections on their causal relationship and the diagnostic value of ultrasonography. Paraplegia. 1995 Aug. 33(8):464-8. [Medline].

  11. Hassard GH. Heterotopic bone formation about the hip and unilateral decubitus ulcers in spinal cord injury. Arch Phys Med Rehabil. 1975 Aug. 56(8):355-8. [Medline].

  12. Downing MR, Knox D, Gibson P, et al. Impact of trochanteric heterotopic ossification on measurement of femoral bone density following cemented total hip replacement. J Orthop Res. 2008 Apr 10. [Medline].

  13. Macfarlane RJ, Ng BH, Gamie Z, et al. Pharmacological treatment of heterotopic ossification following hip and acetabular surgery. Expert Opin Pharmacother. 2008 Apr. 9(5):767-86. [Medline].

  14. Foruria AM, Augustin S, Morrey BF, Sánchez-Sotelo J. Heterotopic ossification after surgery for fractures and fracture-dislocations involving the proximal aspect of the radius or ulna. J Bone Joint Surg Am. 2013 May 15. 95(10):e661-7. [Medline].

  15. Garland DE, Blum CE, Waters RL. Periarticular heterotopic ossification in head-injured adults. Incidence and location. J Bone Joint Surg Am. 1980 Oct. 62(7):1143-6. [Medline].

  16. Singh RS, Craig MC, Katholi CR, et al. The predictive value of creatine phosphokinase and alkaline phosphatase in identification of heterotopic ossification in patients after spinal cord injury. Arch Phys Med Rehabil. 2003 Nov. 84(11):1584-8. [Medline].

  17. Sherman AL, Williams J, Patrick L, et al. The value of serum creatine kinase in early diagnosis of heterotopic ossification. J Spinal Cord Med. 2003. 26(3):227-30. [Medline].

  18. Estrores IM, Harrington A, Banovac K. C-reactive protein and erythrocyte sedimentation rate in patients with heterotopic ossification after spinal cord injury. J Spinal Cord Med. 2004. 27(5):434-7. [Medline].

  19. Banovac K. The effect of etidronate on late development of heterotopic ossification after spinal cord injury. J Spinal Cord Med. 2000 Spring. 23(1):40-4. [Medline].

  20. Freed JH, Hahn H, Menter R, et al. The use of the three-phase bone scan in the early diagnosis of heterotopic ossification (HO) and in the evaluation of Didronel therapy. Paraplegia. 1982 Aug. 20(4):208-16. [Medline].

  21. Bachman DR, Kamaci S, Thaveepunsan S, et al. Preoperative nerve imaging using computed tomography in patients with heterotopic ossification of the elbow. J Shoulder Elbow Surg. 2015 Mar 11. [Medline].

  22. Lindeque BG, Fleming ME, Waterman SS, Lewandowski LR, Chi BB. Use of 3-dimensional stereolithographic polymer models for heterotopic ossification surgical excision. Orthopedics. 2013 Apr 1. 36(4):282-6. [Medline].

  23. Bradleigh LH, Perkash A, Linder SH, et al. Deep venous thrombosis associated with heterotopic ossification. Arch Phys Med Rehabil. 1992 Mar. 73(3):293-4. [Medline].

  24. Varghese G, Williams K, Desmet A, et al. Nonarticular complication of heterotopic ossification: a clinical review. Arch Phys Med Rehabil. 1991 Nov. 72(12):1009-13. [Medline].

  25. Banovac K, Williams JM, Patrick LD, et al. Prevention of heterotopic ossification after spinal cord injury with indomethacin. Spinal Cord. 2001 Jul. 39(7):370-4. [Medline].

  26. Banovac K, Williams JM, Patrick LD, et al. Prevention of heterotopic ossification after spinal cord injury with COX-2 selective inhibitor (rofecoxib). Spinal Cord. 2004 Dec. 42(12):707-10. [Medline].

  27. Choi WJ, Lee JW. Heterotopic ossification after total ankle arthroplasty. J Bone Joint Surg Br. 2011 Nov. 93(11):1508-12. [Medline].

  28. Klaassen MA, Pietrzak WS. Platelet-rich plasma application and heterotopic bone formation following total hip arthroplasty. J Invest Surg. 2011. 24(6):257-61. [Medline].

  29. Genet F, Ruet A, Almangour W, et al. Beliefs relating to recurrence of heterotopic ossification following excision in patients with spinal cord injury: a review. Spinal Cord. 2015 Feb 17. [Medline].

  30. Strauss JB, Chen SS, Shah AP, et al. Cost of radiotherapy versus NSAID administration for prevention of heterotopic ossification after total hip arthroplasty. Int J Radiat Oncol Biol Phys. 2008 Jan 28. [Epub ahead of print]. [Medline].

  31. Strauss JB, Wysocki RW, Shah A, Chen SS, Shah AP, Abrams RA, et al. Radiation therapy for heterotopic ossification prophylaxis afer high-risk elbow surgery. Am J Orthop (Belle Mead NJ). 2011 Aug. 40(8):400-5. [Medline].

  32. Hoff P, Rakow A, Gaber T, Hahne M, Sentürk U, Strehl C, et al. Preoperative irradiation for the prevention of heterotopic ossification induces local inflammation in humans. Bone. 2013 Apr 6. [Medline].

  33. Sautter-Bihl ML, Liebermeister E, Nanassy A. Radiotherapy as a local treatment option for heterotopic ossifications in patients with spinal cord injury. Spinal Cord. Jan 2000. 38(1):33-6.

  34. Banovac K, Gonzalez F, Renfree KJ. Treatment of heterotopic ossification after spinal cord injury. J Spinal Cord Med. 1997 Jan. 20(1):60-5. [Medline].

Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.