What are the treatment options for patients with bone spurs?

Treatment of Bone Spurs

Bone spurs (osteophytes) are treated primarily through a comprehensive non-pharmacological approach centered on exercise, weight loss, and patient education, with pharmacological interventions reserved as adjuncts when conservative measures are insufficient. 1

Core First-Line Treatments (Mandatory for All Patients)

• Exercise therapy focusing on local muscle strengthening and general aerobic fitness must be implemented as the foundation of treatment, as this directly improves pain and function regardless of bone spur location 1, 2

• Weight loss interventions are essential if the patient is overweight or obese, as reducing mechanical stress on affected joints slows disease progression and reduces symptoms 1, 2

• Patient education with both oral and written materials is critical to counter the common misconception that bone spurs and osteoarthritis are inevitably progressive and untreatable 1, 3

Adjunct Non-Pharmacological Treatments

• Local heat or cold applications provide temporary symptomatic relief and should be recommended for home use 1, 2, 4

• Shock-absorbing footwear or insoles reduce joint loading and are particularly important for lower extremity bone spurs 1, 2

• Bracing, joint supports, or orthoses should be assessed for patients with biomechanical joint pain or instability, with hand orthoses specifically recommended for hand involvement 1, 2

• Assistive devices (walking sticks, tap turners) help patients with specific functional limitations in activities of daily living 1, 2, 4

• Manual therapy (manipulation and stretching) may be beneficial, particularly for hip involvement, when combined with supervised exercise 1, 4

Pharmacological Treatment Algorithm

Step 1: First-Line Analgesics

• Paracetamol (acetaminophen) should be tried first for pain relief, with regular dosing up to 4000 mg/day as needed 1, 3

• Topical NSAIDs should be considered before oral NSAIDs, particularly for knee and hand bone spurs, as they provide similar efficacy with fewer systemic adverse effects 1, 3

Step 2: Oral NSAIDs (If Step 1 Insufficient)

• Oral NSAIDs or COX-2 inhibitors should be prescribed at the lowest effective dose for the shortest possible period when paracetamol and topical NSAIDs fail 1, 3

• Proton pump inhibitor co-prescription is mandatory with all oral NSAIDs or COX-2 inhibitors to reduce gastrointestinal toxicity 1, 2

• Assess cardiovascular, gastrointestinal, and renal risk factors before prescribing oral NSAIDs, particularly in elderly patients and those with comorbidities, as all oral NSAIDs carry similar analgesic efficacy but vary significantly in toxicity profiles 1, 3

Step 3: Additional Options for Refractory Pain

• Opioid analgesics may be added or substituted if previous treatments provide insufficient relief 1, 4

• Intra-articular corticosteroid injections should be considered for moderate to severe pain, particularly when joint effusion is present 1, 2

• Topical capsaicin can be considered as an adjunct for localized pain 1

Critical Pitfalls to Avoid

• Do NOT recommend glucosamine or chondroitin products, as current evidence does not support their efficacy beyond placebo 1, 3, 5

• Do NOT use electroacupuncture, as it should not be offered based on available evidence 1, 3

• Do NOT refer for arthroscopic lavage and debridement unless there is a clear history of mechanical locking in knee osteoarthritis, as these procedures show no benefit over sham procedures 1, 5

Surgical Considerations

• Joint replacement surgery should be considered only for patients with symptoms (pain, stiffness, reduced function) that substantially affect quality of life and remain refractory to non-surgical treatment after core treatments have been optimally implemented 1, 4

• Referral should occur before prolonged and established functional limitation develops, and patient-specific factors (age, sex, smoking, obesity, comorbidities) should not be barriers to referral 1

Special Considerations by Location

For Calcaneal Spurs

• The treatment follows the same tiered approach, with particular emphasis on shock-absorbing footwear and weight reduction 6

For Hand Bone Spurs

• Hand orthoses are specifically recommended and should be offered to all patients with hand involvement 1

For Spine Bone Spurs

• Isometric strengthening exercises are particularly important, starting with low-intensity contractions (30% of maximal voluntary contraction) and gradually increasing to 75% as tolerated 4

Monitoring and Follow-Up

• Regular assessment of treatment effectiveness is essential, as disease course and patient needs change over time, requiring adjustment of the treatment plan 2, 3

• When prescribing NSAIDs in elderly patients, ongoing monitoring of cardiovascular, gastrointestinal, and renal function is necessary given their increased baseline risk 1, 3