BACKGROUND: Long-term alendronate use has been associated with tendinopathies and ligament disorders that may result in chronic pain and functional impairment. Platelet-rich plasma (PRP) therapy has emerged as a regenerative treatment option for chronic tendinopathies by promoting tissue healing and improving pain and function.

CASE REPORT: A 61-year-old woman with an athletic lifestyle took alendronate for 14 years for osteopenia before she stopped taking it. Nine years later, she reported chronic right hamstring complex pain and loss of function after sustaining a lifting injury. She underwent conservative therapy, including stretching exercises and physical therapy and had an evaluation by an orthopedic surgeon. Her pain and function did not improve. She was referred to an interventional pain management physician who diagnosed her with chronic semimembranosus tendinopathy. She was initially treated with a 3-injection series of 12.5% dextrose prolotherapy which did not provide lasting pain relief nor lasting functional improvement. Her treatment was then changed to a holistic regimen of ultrasound-guided leukocyte-poor platelet-rich plasma injections, a post platelet-rich plasma physical therapy program, and acupuncture. This holistic treatment program enabled her to attain 90%-95% pain relief and a significantly improved functional status and quality of life.

CONCLUSION: Platelet-rich plasma injection therapy is an evolving area in Medicine. It holds much promise for those in need of musculoskeletal repair, pain relief and improved function without the need for surgery or chronic use of medications. Much work remains to be done in developing more standardization of platelet-rich plasma therapy, but medical specialists are moving in the right direction as we become more sophisticated and attune in studying, understanding and implementing the potential that platelet-rich plasma injection therapy holds for healing. Incorporation of leukocyte-poor platelet-rich plasma using holistic treatment of chronic semimembranosus tendinopathy associated with chronic use of alendronate was much more effective for pain reduction and restoration of function as compared to only more conservative therapies of physical therapy, stretching exercises, acupuncture, and dextrose prolotherapy.

KEYWORDS: Platelet-rich plasma, alendronate, bisphosphonates, prolotherapy, tendinopathy