Drug for the treatment of osteonecrosis and for the management of patients at risk of developing osteonecrosis

1. A method of treating a patient with one or more of the group consisting of osteonecrosis and osteochondritis dissecans, the method comprising administering to the patient a drug consisting essentially of at least one bisphosphonate or any pharmaceutically acceptable salt, hydrate or ester thereof.

2. The method of claim 1 wherein the bisphosphonate is zoledronic acid or any pharmaceutically acceptable salt, hydrate or ester thereof.

3. The method of claim 1 wherein the bisphosphonate is selected from the group consisting of pamidronate, alendronate, etidronate, clodronate, risedronate, tiludronate, ibandronate, incadronate, minodronate, olpadronate, neridronate, EB-1053 or any pharmaceutically acceptable salt, hydrate or ester thereof.

4. The method of claim 1 wherein the drug is intravenously administered to a subject.

5. The method of claim 1 wherein the drug is administered either orally, subcutaneously, intramuscularly, transdermally, or topically to a subject.

6. The method of claim 1 wherein the drug is administered locally to a target treatment site.

7. The method of claim 6 wherein the drug is administered prior to, at the time of, or after, a core decompression procedure.

8. The method of claim 6 wherein the drug is administered prior to, at the time of, or after, a bone grafting procedure.

9. The method of claim 6 wherein the drug is administered prior to, at the time of, or after, a vascularized bone grafting procedure.

10. The method of claim 6 wherein the drug is administered together with a local delivery system.

11. The method of claim 10 wherein the local delivery system is one or more of the group consisting of a bone graft substitute, bone graft extender, autogenous bone graft and allogenic bone graft.

12. The method of claim 10 wherein the local delivery system further comprises bone morphogenetic proteins.

13. The method of claim 12 wherein the bone morphogenetic proteins are selected from the group consisting of bone morphogenetic protein 7 (OP-1), bone morphogenetic protein 2 and bone morphogenetic protein 4.

14. The method of claim 10 wherein the local delivery system further comprises one or more of the group consisting of transforming growth factor beta, insulin-like growth factor-1, insulin-like growth factor-2, fibroblast growth factor 1 and fibroblast growth factor 2.

15. The method of claim 2 wherein the bisphosphonate zoledronic acid or any pharmaceutically acceptable salt, hydrate or ester thereof is administered parenterally in a dose range of 0.25 mg to 12 mg in an adult patient or 0.005 mg/kg to 0.5 mg/kg in a child up to every three months.

16. The method of claim 2 wherein the zoledronic acid or any pharmaceutically acceptable salt, hydrate or ester thereof is administered four-weekly, six-weekly or every two months.

17. The method of claim 2 wherein the bisphosphonate zoledronic acid or any pharmaceutically acceptable salt, hydrate or ester thereof is administered every twelve months.

18. The method of claim 2 wherein the zoledronic acid is administered parenterally as a single dose.

19. The method of claim 3 wherein the bisphosphonate is pamidronate or any pharmaceutically acceptable salt, hydrate or ester thereof administered parenterally in a dose range of 15 to 90 mg every one to six months in an adult patient or 0.25 mg/kg to 3.0 mg/kg every one to six months in a child.

20. The method of claim 3 wherein the bisphosphonate is alendronate or any pharmaceutically acceptable salt, hydrate or ester thereof administered orally in a dose range from 2.5 mg to 50 mg per day or 10 mg to 300 mg per week for an adult patient and from 0.05 mg/kg to 1.0 mg/kg per day or 0.2 mg/kg to 6.0 mg/kg per week in a child.

21. The method of claim 3 wherein the alendronate is administered parenterally in a dose range of 0.25 mg to 30 mg every one to three months, or as a single dose.

22. The method of claim 3 wherein the bisphosphonate is risedronate or any pharmaceutically acceptable salt, hydrate or ester thereof administered orally in a dose range of 2.5 mg to 60 mg per day or 10 mg to 300 mg per week in an adult patient or 0.05 mg/kg to 1.0 mg/kg per day or 0.25 mg/kg to 7.0 mg/kg per week in a child.

23. The method of claim 3 wherein the bisphosphonate is ibandronate or any pharmaceutically acceptable salt, hydrate or ester thereof administered parenterally in a dose range of 0.25 mg to 30 mg every one to three months, or as a single dose.

24. The method of claim 3 wherein the ibandronate is administered orally in a dose range of 2.5 mg to 30 mg per day, or 15 mg to 210 mg per week in an adult patient or 0.05 mg/kg to 0.5 mg/kg per day or 0.25 mg/kg to 2.5 mg/kg per week for a child.

25. The method of claim 3 wherein the bisphosphonate is incadronate or any pharmaceutically acceptable salt, hydrate or ester thereof administered parenterally in a dose range of 0.25 mg to 30 mg in an adult patient or 0.005 mg/kg to 0.6 mg/kg, in a child wherein said dose is administered every one to three months, or as a single dose.

26. The method of claim 3 wherein the bisphosphonate is minodronate or any pharmaceutically acceptable salt, hydrate or ester thereof administered parentally in a dose range of 0.25 mg to 30 mg every one to three months, or as a single dose.

27. The method of claim 3 wherein the bisphosphonate is clodronate or any pharmaceutically acceptable salt, hydrate or ester thereof administered orally in a dose range of 400 mg to 2400 mg per day or administered intravenously in dose ranges from 150 mg to 300 mg repeated daily for 2 to 5 days.

28. The method of claim 3 wherein the bisphosphonate is etidronate or any pharmaceutically acceptable salt, hydrate or ester thereof administered orally in a dose range of 100 mg to 400 mg per day or 5 mg to 20 mg/kg per day in a child.

29. The method of claim 3 wherein the bisphosphonate is tiludronate or any pharmaceutically acceptable salt, hydrate or ester thereof administered orally in a dose of 400 mg per day in an adult or 5 mg to 20 mg/kg per day in a child.

30. The method of claim 3 wherein the bisphosphonate is olpadronate or any pharmaceutically acceptable salt, hydrate or ester thereof administered orally in a dose range of 50 mg to 400 mg per day in an adult or 1 mg/kg to 10 mg/kg in a child or administered intravenously every one to three months in dose ranges from 1 mg to 20 mg in an adult or 0.1 mg/kg to 0.5 mg/kg in a child.

31. The method of claim 3 wherein the bisphosphonate is neridronate or any pharmaceutically acceptable salt, hydrate or ester thereof administered parenterally in a dose range of 10 mg to 100 mg in an adult.