This review aims to evaluate the evidence regarding effectiveness of intravenous pamidronate in individuals with complex regional pain syndrome type I (CRPS I), focusing on pain reduction, functional outcomes, and dosing strategies. "PsycINFO, PubMed, EMBASE, SCOPUS, Web of Science, PEDro, and CINAHL" were searched until October 2025. The quality of the studies was evaluated using the Physiotherapy Evidence Database (PEDro) scale for randomized controlled trials (RCTs), the ROBINS-I tool for non-randomized controlled trials (non-RCTs), and the Newcastle-Ottawa Scale for observational studies. Seven studies met the eligibility criteria. Two studies were of high quality, two had a high risk of bias, and three had a moderate risk of bias. The meta-analysis of three studies showed a non-significant effect size of 0.722 (Cohen's d, p = 0.381) with high heterogeneity (Q = 17.203, p < 0.001; I[2] = 88%) and a wide prediction interval (-19.257 to 20.701), highlighting high uncertainty and the need for cautious interpretation due to the limited studies. Intravenous pamidronate may offer symptom relief for individuals with CRPS I, particularly in reducing pain and edema and improving function. Given the heterogeneity of the studies and limited sample sizes, findings should be interpreted as preliminary and hypothesis-generating rather than definitive.

Primary liver cancer is a leading cause of cancer-related death worldwide, and hepatocellular carcinoma (HCC) accounts for most cases. This study aimed to clarify the expression pattern, biological role, therapeutic relevance, and phosphoproteomic impact of farnesyl diphosphate synthase (FDPS) in HCC. FDPS expression was assessed in public datasets and clinical specimens using quantitative real-time polymerase chain reaction and immunohistochemistry. Its function was investigated through small interfering RNA-mediated silencing, lentiviral overexpression, pamidronate treatment, in vitro proliferation, migration, invasion, and apoptosis assays, xenograft models, phosphoproteomic profiling, and Western blot validation. FDPS was upregulated in HCC tissues and was potentially associated with poorer survival. FDPS silencing reduced HCC cell proliferation, migration, invasion, and tumorigenicity and increased apoptosis, whereas FDPS overexpression produced opposite effects. Pamidronate, a selective FDPS inhibitor, suppressed malignant phenotypes in vitro and inhibited tumor growth in vivo. Phosphoproteomic analysis revealed extensive phosphorylation changes after FDPS depletion, with enrichment in pathways related to GTPase and protein kinase C activation, glucose metabolism, cytoskeletal remodeling, immune regulation, cell cycle control, Golgi function, and ErbB and phospholipase D signaling. FDPS knockdown was further associated with decreased B-cell lymphoma 2 expression, reduced phosphorylation of Caspase-9 at Ser196, increased cleaved Caspase-3, and reduced phosphorylation of mechanistic target of rapamycin at Ser2448. Collectively, these findings suggest that FDPS contributes to HCC progression and may serve as a candidate biomarker and therapeutic target.

A 65-year-old man with a history of thyrotropin (TSH)-secreting pituitary adenoma presented with progressive spinal pain 7 years after diagnosis. Laboratory examinations revealed hyperthyroidism with markedly elevated TSH 28.5 mIU/mL (reference range, 0.3-5.0 mIU/mL) and a large pituitary tumor. Despite 3 transsphenoidal surgeries and long-term octreotide therapy, the tumor gradually enlarged. Radioiodine (RAI) therapy using iodine-131 (I-131; hereafter "I-131 therapy") was administered for refractory thyrotoxicosis, after which thyroid hormone levels normalized but TSH rose dramatically (>500 mIU/mL). Subsequently, magnetic resonance imaging (MRI) revealed multiple spinal metastases. Biopsy of a vertebral lesion demonstrated chromophobic adenocarcinoma with positive TSH immunostaining, confirming metastatic TSH-secreting pituitary carcinoma. Palliative spinal irradiation and pamidronate temporarily relieved symptoms, but the patient died of pneumonia 8 years after onset. Autopsy revealed widespread bone metastases without any other primary malignancy. This case illustrates the malignant transformation of a TSH-secreting pituitary adenoma into carcinoma with distant bone metastases and suggests that I-131 therapy may have accelerated tumor progression. Early recognition of central hyperthyroidism and avoidance of I-131 therapy before pituitary-directed therapy are crucial to prevent treatment-related tumor exacerbation.

Bisphosphonates (BPs) are widely used for managing tumor metastasis and bone diseases, associated with a rare complication of medication-related osteonecrosis of the jaws (MRONJ). Though reasons are still debated, the MRONJ occurrence in paediatric population suffering osteogenesis imperfecta (OI) and treated with BPs is absent. Here, we reported a 33-year-old patient with OI (Type III) who developed MRONJ after receiving intravenous pamidronate from 16 years old. She complained of intermittent nasal bleeding for six years, and presented an exposed necrotic bone in the left maxilla. She underwent surgical debridement, and pathological examination confirmed MRONJ. To our knowledge, this was a very rare case of MRONJ in an adult with OI type III following pediatric BP exposure. This case underscored the need for long-term vigilance, as delayed onset into adulthood is possible. Clinicians should pay attention to sinonasal symptoms as potential manifestations of MRONJ, and strengthen dental preventive care to reduce local risk factors. Long-term follow-up longitudinal studies with a larger sample size in this population are needed.

In this case, a patient presented to the emergency department (ED) with fatigue after CareNow noted abnormal laboratory results. The patient reported using trenbolone, an anabolic-androgenic steroid (AAS) often used for athletic performance enhancement or cosmetic purposes. In the ED, the patient was noted to have significant hypercalcemia (15 mg/dL) and acute kidney injury (AKI) (creatinine 6.02 mg/dL). The workup ruled out malignancy, hyperparathyroidism, and vitamin D toxicity. The patient was admitted and received intravenous fluids and pamidronate, which improved the patient's hypercalcemia and AKI. This case adds to the limited literature on metabolic and renal dysfunction associated with AAS use. Additionally, this case highlights the importance of a thorough history, including supplements and nonprescribed substances that patients may be using, as these can contribute significantly to their presentation and care.

Langer-Giedion syndrome (LGS), also known as trichorhinophalangeal syndrome type II (TRPS II; OMIM #150230), is a contiguous-gene deletion disorder caused by haploinsufficiency of TRPS1 and EXT1. Cornelia de Lange syndrome (CdLS) is genetically heterogeneous; heterozygous variants in RAD21 cause the milder CdLS type 4 phenotype (OMIM #614701). Because RAD21 lies between TRPS1 and EXT1, overlapping phenotypes may arise when all three genes are deleted. We report a unique case of a 4-year-old female presenting with a blended phenotype of Langer-Giedion Syndrome (LGS) and Cornelia de Lange Syndrome (CdLS) type 4. This case is distinct from previously reported 8q deletions in three key aspects: (1) Complex Genomic Architecture: Chromosomal microarray revealed a novel complex rearrangement consisting of a 13.01 Mb mosaic interstitial deletion at 8q23.1-q24.12, flanked by two large duplications (21.5 Mb at 8q11.23-q23.1 and 25.78 Mb at 8q24.12-q24.3). (2) Rare Mosaicism: This represents only the second reported case of mosaicism affecting this contiguous gene region. Notably, the patient demonstrates a "mosaic rescue" effect, where the mosaicism appears to have mitigated the neurodevelopmental phenotype (the patient is bilingual and ambulatory) while failing to protect the skeleton. (3) First Bone-Specific Therapy: The patient suffered from severe, recurrent fractures due to a synergistic "double hit" of TRPS1-related osteopenia and EXT1-related exostoses. We report the first successful use of bisphosphonate therapy (pamidronate) in this specific mosaic profile, which resulted in a complete cessation of fractures during a 12-month follow-up. This case underscores the utility of detailed microarray analysis in complex phenotypes and suggests bisphosphonates as a viable rescue therapy for refractory syndromic osteoporosis.

Bone metastasis is a significant challenge in the treatment of advanced breast cancer, with current treatments mainly providing symptom relief without addressing the osteolytic cycle driven by tumor cells and osteoclasts, which leads to continuous bone destruction and tumor progression. Pamidronate (APD), a nitrogen-containing bisphosphonate, has shown potential in managing osteolytic lesions by inhibiting osteoclast activity. However, its clinical application is hindered by rapid systemic clearance and off-target effects. Herein, we developed a multifunctional injectable hydrogel (CHA) by covalently conjugating APD to enhance localized delivery, reduce toxicity, and target both tumor progression and bone degradation to disrupt osteolytic cycle. The CHA hydrogel induces membrane calcification in tumor cells, forming a mineralized layer that impairs nutrient exchange and suppresses tumor growth. Concurrently, CHA modulates the bone microenvironment by downregulating PTHrP expression, inhibiting osteoclastogenesis, and promoting osteogenesis through the upregulation of OPG and RUNX2. Both in vitro and in vivo experiments demonstrated that CHA significantly inhibited tumor growth, prevented bone loss, and facilitated bone regeneration. Moreover, CHA exhibited excellent biocompatibility with no observed systemic toxicity. These results underscore the promise of CHA as a clinically translatable therapeutic strategy for the treatment of osteolytic bone metastases.

Our case study highlights the challenges in treating chronic non-bacterial osteitis/osteomyelitis (CNO) of the jaw and supports the current recommendations for diagnosis and treatment, which prioritize newly defined drug treatment strategies. The implementation of regular reevaluations-including magnetic resonance imaging (MRI) if necessary-is essential for the desired treat-to-target strategy. The patient care should be carried out in centers with an interdisciplinary approach and experience in the treatment of CNO.