Intralesional Triamcinolone versus Oral Bisphosphonate for Benign Cystic Bone Lesions: A Prospective Comparative Study of Radiological and Pain Outcomes

Introduction: Benign cystic bone lesions, particularly solitary bone cysts and aneurysmal bone cysts, predominantly affect children and adolescents, posing significant orthopedic challenges. Aim: This study was therefore designed to compare intralesional triamcinolone injection and oral bisphosphonate therapy in patients with benign cystic bone lesions, with respect to radiological healing and pain outcomes over a 6-month follow-up period. Materials and Methods: This prospective study enrolled 60 patients with benign cystic bone lesions at the Department of Orthopedics and Trauma Centre, J.A. Group of Hospitals, Gwalior, India. Patients were randomly allocated to Group A (intralesional triamcinolone injection, n = 30) or Group B (oral bisphosphonate, n = 30). Radiological outcomes were assessed using Cole's modification of the Neer grading system, and pain was measured using the Visual Analog Scale (VAS) at baseline, 1, 3, and 6 months. Statistical analyses included the Mann-Whitney U test and McNemar's test. Results: Both groups were comparable at baseline for age, gender, pain duration, and side of involvement. At 6 months, Group A demonstrated significantly superior pain reduction (VAS: 1.48 ± 1.33) compared to Group B (VAS: 5.48 ± 1.50; P < 0.001). Radiological improvement (decrease in Neer grade) occurred in 60% of Group A vs 40% in Group B (P = 0.03). Internal calcification and mineralization were significantly more frequent in Group A (40%) than Group B (16.7%; P = 0.044). Neer-Cole Grade 1 (complete healing) was achieved in 56.67% of Group A versus 23.33% of Group B. Conclusion: Intralesional triamcinolone injection demonstrated superior efficacy compared to oral bisphosphonate in managing benign cystic bone lesions with respect to pain reduction, radiological improvement, and promotion of calcification. Bisphosphonates remain valuable as adjunctive or alternative therapy in specific clinical scenarios. Larger randomized controlled trials with long-term follow-up are warranted.