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General Rehabilitation

Intravenous Pamidronate Treatment for Acute Heterotopic Ossification (HO) of the Hip in a Patient with Spinal Cord Injury

Thursday, October 23, 2025
12:45 PM - 2:15 PM MT
Location: Kiosk 1

    Primary Author(s)

  • Colton Higuera, DO

    Resident Physician
    University of Kansas Medical Center PM&R Program
    Kansas City, Kansas

    • Co-Author(s)

  • Logan Leavitt, DO

    Intervention Spine & MSK Fellow
    Barrow Neurological Institute
    Tempe, Arizona

  • SF

    Stephanie Fortune, DO

    Resident Physician
    University of Kansas Medical Center PM&R Program
    Kansas City, Kansas

  • NR

    Namrata Raut, MD

    Assistant professor
    University of Kansas
    Overland Park, Kansas

Disclosure(s):
Colton Higuera, DO: No financial relationships to disclose
Logan Leavitt, DO: No financial relationships to disclose
Case Diagnosis: C2 AIS C SCI with acute left hip HO treated with IV pamidronate and celecoxib

Case Description or Program Description: A 25-year-old male with no prior medical history sustained a C7 compression fracture and C6-C7 anterolisthesis after a fall, resulting in C2 AIS C SCI (spinal cord injury) and requiring C7 corpectomy with C4-T5 fusion. Six weeks post-injury, he developed left hip swelling and reduced ROM, impairing mobility. Radiographs confirmed early heterotopic ossification (HO). Due to a recent GI bleed, IV pamidronate (90 mg) was administered, followed by oral celecoxib, a selective COX-2 inhibitor, to prevent progression.

Setting: Acute Inpatient Rehab

Assessment/Results: Three days post-infusion, erythrocyte sedimentation rate (ESR) decreased by 60%, with a 90% reduction at two weeks, correlating with significantly improved ROM. The patient’s hip flexion improved from 70° to 90°, abduction from 20° to 30°, and external rotation from 10° to 20°. He reported less swelling and a lighter sensation in his lower extremity, allowing for greater ease in functional activities such as leg crossing for dressing. The patient’s improved mobility was maintained out to three months with plans for close follow up with radiographic imaging to monitor for HO progression.

Discussion (relevance): HO is a common complication of SCI, causing pain, joint restriction, and functional impairment. With etidronate no longer available in the U.S., alternative treatments are needed. While pamidronate is used perioperatively to prevent HO recurrence, its role in non-surgical cases remains unclear. This case suggests IV pamidronate with celecoxib may reduce inflammation and limit HO progression, particularly for patients who cannot tolerate non-selective NSAIDs, as evidenced by rapid ESR reduction, sustained ROM improvements, and stable HO findings.

Conclusions: The combination of IV pamidronate and celecoxib provided rapid symptom relief, improved ROM, and stable HO findings in this patient. Further research is warranted to assess its broader application in non-surgical HO management in SCI patients.