Is red light therapy effective for treating bone necrosis?

Red Light Therapy for Bone Necrosis

Red light therapy (photobiomodulation) is not recommended as a standard treatment for bone necrosis, as current clinical practice guidelines do not support its use and evidence remains insufficient. 1

Current Evidence-Based Treatment Standards

The most recent guidelines from major medical societies establish clear treatment algorithms for bone necrosis that do not include red light therapy as a recommended intervention:

For Medication-Related Osteonecrosis of the Jaw (MRONJ)

• Stage 1: Antimicrobial mouth rinses, meticulous oral hygiene, and minor surgical procedures (sequestration or removal of dead bone) are recommended 1
• Stage 2: Antibacterial oral rinses, systemic antibiotic therapy when infection is present, pain control with analgesics, and conservative surgical debridement 1
• Stage 3: Pain control, infection management with antibiotics, and surgical debridement or resection when conservative therapy fails 1

For Avascular Necrosis of Long Bones

The American College of Radiology (2022) identifies established noninvasive therapies with limited supporting data, including statins, bisphosphonates, anticoagulants, extracorporeal shock wave therapy, and hyperbaric oxygen—but notably does not include red light therapy 1

Surgical interventions remain the primary evidence-based approach:

• Core decompression for early-stage disease (before articular collapse) 1, 2, 3
• Resurfacing hemiarthroplasty or total joint arthroplasty for late-stage disease with articular collapse 1, 2, 3

Limited Evidence for Alternative Therapies

Hyperbaric Oxygen (HBO)

One randomized controlled trial showed modest benefit when HBO was added to conventional surgery and antibiotics for MRONJ, with improved healing rates (odds ratio 3.45) but no significant differences in complete healing or quality of life 1

Photobiomodulation/Laser Therapy Status

The ASCO/MASCC guideline (2019) explicitly states that "evidence remains limited for alternative therapies, such as hyperbaric oxygen, low-level laser treatment, and plasma-rich growth factors" 1

The 2024 ISOO-MASCC-ASCO guideline on osteoradionecrosis makes no recommendation regarding photobiomodulation therapy due to "limited, low-quality available evidence" 1

Critical Clinical Pitfalls

• Early diagnosis is essential to prevent articular collapse and preserve treatment options, particularly for avascular necrosis of the femoral head and humeral head 1, 2, 3
• Lesion size determines prognosis: Necrotic volume >30% of the femoral or humeral head has 46-83% risk of progression to collapse, while <30% involvement has <5% risk 1, 2, 3
• Bilateral involvement occurs in 70-80% of nontraumatic cases, requiring evaluation of both sides 2, 3
• Multifocal disease is common, potentially affecting hip, knee, ankle, and shoulder simultaneously 1, 2, 3

Recommended Management Algorithm

For epiphyseal osteonecrosis (femoral head, humeral head, talus):

1. Begin with plain radiographs to exclude other causes, followed by MRI for definitive diagnosis and staging 1, 2
2. Quantify necrotic volume—this is the single most important prognostic factor 1, 2, 3
3. For early-stage disease (<30% involvement, no collapse): Consider core decompression 1, 2, 3
4. For late-stage disease (>30% involvement or articular collapse): Plan for arthroplasty 1, 2, 3

For medication-related osteonecrosis of the jaw:

1. Stage 1: Conservative management with oral hygiene and antimicrobial rinses 1
2. Stage 2-3: Surgical debridement combined with antibiotic therapy when infection is present 1
3. Follow-up every 8 weeks with dental specialist 1

Red light therapy lacks the evidence base to be incorporated into these established treatment pathways and should not delay definitive surgical or medical management.