The role of Iloprost on bone edema and osteonecrosis: Safety and clinical results

ABSTRACT

Introduction: Iloprost is a commercially available prostaglandin I₂ (PGI₂) analogue that is shown to have antithrombotic, vasodilatative and antiproliferative effects. A number of clinical studies have shown that Iloprost can be effective in the management of bone marrow oedema and the treatment of avascular necrosis. The aim of this manuscript is to present our current understanding on the effect of Iloprost on the treatment of these conditions.

Areas covered: The authors offer a comprehensive review of the existing literature on the experimental and clinical studies analysing the effect of Iloprost on bone, bone marrow oedema and avascular necrosis.

Expert opinion: The available data from the clinical studies suggest that Iloprost has limited effect in advanced stages of avascular necrosis. However, literature suggests that Iloprost administration can be a viable option in the management of bone marrow oedema and early stages of osteonecrosis. Despite these promising results its effect on bone homeostasis needs further elucidation. Moreover, further data on its safety, dosage and efficiency through randomized multicenter studies are desirable in order to reach final conclusions.

KEYWORDS:

• Iloprost
• prostacycline
• bone marrow oedema
• osteonecrosis
• avascular necrosis

Article highlights

• Iloprost is a prostangladin I₂ analogue with antithrombotic, vasodilatative and antiproliferative effects.

• Iloprost is commercially available and is licenced for the treatment of arterial pulmonary hypertension. However, its off-licence uses are wide ranging from treatment of thromboangiitis obliterans, scleroderma to renal dysfunction and limb ischemia.

• The available in-vitro and animal evidence suggest that Iloporst can interfere with bone homeostasis and delays fracture healing in animals. These studies are limited and require further elucidation.

• Based on the clinical studies it seems that Iloprost could be a viable option in the management of bone marrow oedema and early stages of osteonecrosis.

• Further research and multicenter clinical trials on the field are needed. 


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Conflict of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.