[Pharmacological therapy for subchondral pathologies of the knee joint]

Pathologies of the subchondral bone include both structural alterations such as osteonecrosis and bone marrow edema. Both entities are amenable to pharmacological therapy.

Presentation of current recommendations for drug therapy of osteonecrosis and bone marrow edema of the knee joint based on the clinical data.

The currently available literature is evaluated and discussed.

Antiresorptives such as bisphosphonates and denosumab and the osteoanabolic agent teriparatide therapeutically address the locally diminished bone density potentially resulting in insufficiency fractures. In contrast, vitamin K antagonists, heparin and new/direct oral anticoagulants, as well as iloprost exert their effects at the vascular and hemostatic level. All drug treatment concepts are "off-label" use. They are particularly promising in the early stages of primary, idiopathic osteonecrosis and bone marrow edema.

In osteonecrosis and bone marrow edema of the knee joint, complementary drug therapy may be beneficial. However, the available data is not yet sufficiently robust for general treatment recommendations.