From the Guidelines
Osteitis pubis should be treated with non-steroidal anti-inflammatory drugs (NSAIDs) or cyclooxygenase-2 inhibitors (COXIBs) as the first-line treatment, according to the expert consensus recommendations for the diagnosis and treatment of chronic non-bacterial osteitis (CNO) in adults 1. The treatment goals for osteitis pubis include relieving symptoms, maintaining or regaining functional capacity, reducing inflammation, and preventing structural musculoskeletal damage. The following key points are essential in the management of osteitis pubis:
- Assess disease activity based on clinical symptoms and radiological measures, including bone marrow oedema or increased tracer uptake in the clinically and/or radiologically suspect lesions 1.
- Provide patient education and lifestyle recommendations, consider physiotherapy and dental examination, and short courses of oral prednisolone or intra-articular glucocorticoid injections may be considered as bridging options 1.
- For persistent cases, second-line treatment with intravenous bisphosphonates (IVBP) or tumour necrosis factor-α inhibitors (TNFi) may be necessary, with the choice between them individualized based on patient characteristics 1.
- Monitor adverse treatment effects according to established guidelines and be aware of potential complications such as neurovascular complications and vertebral fractures 1. The treatment approach should be tailored to the individual patient, taking into account the presence of additional inflammatory features and the risk of complications. Regular follow-up and evaluation of treatment response are crucial to ensure optimal management of osteitis pubis. In cases where there is insufficient response to first-line and second-line treatments, referral to an expert center for consideration of third-line treatment options may be necessary 1.
From the Research
Definition and Diagnosis of Osteitis Pubis
- Osteitis pubis is an infrequent complication of pelvic surgery, parturition, or athletic activities 2
- The diagnosis is made on the basis of the typical findings of pubic tenderness and pain on hip abduction that occurs a few weeks following the inciting event 2
- Confirmatory radiographs, bone scans, and magnetic resonance imaging aid the diagnosis 3
Treatment Options for Osteitis Pubis
- Initial treatment consists of rest, physical therapy, and oral nonsteroidal or glucocorticoid anti-inflammatory medications 2
- The use of intra-articular glucocorticoid injections is controversial 2
- Corticosteroid injections, wedge resection of the symphysis, curettage, and arthrodesis have all been used with variable success 3
- A study found that a more rapid return to intercollegiate athletics can be achieved through the judicious use of corticosteroid injections 4
Rehabilitation and Return to Training
- Conservative treatment represents the first-line approach and provides good results in most patients, especially if based on an individualized multimodal rehabilitative management 5
- Different surgical options have been also described, but they should be reserved to recalcitrant cases 5
- A systematic review found that there were no randomised controlled trials identified, and the current medical literature shows only level 4 evidence of the treatment for osteitis pubis in athletes 6