Efficacy of antiresorptive agents in fibrous dysplasia and McCune Albright syndrome, a systematic review and meta-analysis

Rev Endocr Metab Disord. 2023 Dec;24(6):1103-1119. doi: 10.1007/s11154-023-09832-2. Epub 2023 Aug 26.


Fibrous dysplasia (FD) is a rare skeletal disorder in which normal bone is replaced by a fibro-osseous tissue, resulting in possible deformities and fractures. The aim of this systematic review and meta-analysis was to synthesize the available evidence on the use of antiresorptive drugs in FD in terms of changes in bone turnover markers (BTMs), bone mineral density (BMD), and reducing pain. Three databases were searched in October 2022, with an update in July 2023. Of the 1037 studies identified, 21 were retained after eligibility assessment. A random-effects model was used to calculate global effect size and the corresponding standard error. Pamidronate and Denosumab were the most reported drugs in a total of 374 patients assessed. The initiation of treatments was accompanied by an average reduction of 40.5% [CI95% -51.6, -29.3] in the bone resorption parameters, and 22.0% [CI95% -31.9, -12.1] in the parameters of bone formation after 6-12 months. BMD was increased in both FD lesions and in the unaffected skeleton. Pain was reduced by 32.7% [CI95% -52.7, -12.6] after 6-12 months of treatment, and by 44.5% [CI95% -65.3, -23.6] after a mean 41.2 months of follow-up. The variation in pain was highly correlated to variation in bone resorption (R2 = 0.08, p < 0.0001) and formation parameters (R2 = 0.17, p < 0.0001). This study supports the overall efficacy of antiresorptive therapies in terms of reducing bone remodeling, improving bone density, and pain in FD.

Keywords: Antiresorptive; Bisphosphonates; Denosumab; Fibrous dysplasia of bone; McCune-Albright syndrome; Meta-analysis.

Publication types

  • Meta-Analysis
  • Systematic Review
  • Review

MeSH terms

  • Bone Density Conservation Agents* / therapeutic use
  • Bone Resorption* / chemically induced
  • Bone Resorption* / complications
  • Bone Resorption* / drug therapy
  • Diphosphonates / therapeutic use
  • Fibrous Dysplasia of Bone* / complications
  • Fibrous Dysplasia of Bone* / drug therapy
  • Fibrous Dysplasia of Bone* / pathology
  • Fibrous Dysplasia, Polyostotic* / complications
  • Fibrous Dysplasia, Polyostotic* / drug therapy
  • Humans
  • Pain / chemically induced
  • Pain / complications
  • Pain / drug therapy


  • Bone Density Conservation Agents
  • Diphosphonates