A Multicenter, Prospective, Randomized Controlled Trial to Evaluate the Efficacy and Safety of Bisphosphonates Combined with Vancomycin in the Treatment of Refractory Osteomyelitis

Inclusion Criteria:

• Patients diagnosed with chronic osteomyelitis (Cierny-Mader type I and III) based on clinical manifestations (local pain, redness and swelling, sinus tract formation, etc.), laboratory findings (elevated white blood cell count, neutrophil ratio, CRP and ESR, positive pathogenic bacterial culture), and typical imaging features (X-ray, CT, MRI), and who require debridement surgery.
• Pathogen susceptibility testing confirms the causative organism as Staphylococcus aureus or methicillin-resistant Staphylococcus aureus (MRSA).
• Subjects aged 18 to 65 years.
• Male or female subjects.
• Written informed consent is obtained from the subject and their family members.
• The study protocol has been approved by the hospital ethics committee.
• Willing and able to comply with the study protocol, scheduled follow-up, and toxicity management as judged by the study investigators.

Exclusion Criteria:

• Known hypersensitivity or resistance to the components of the product (bisphosphonates, vancomycin)NCBI.
• Currently on long-term bisphosphonate therapy, or having received intravenous bisphosphonates within the past year.
• Patients with systemic infectious diseases (sepsis, bacteremia, or septicemia) or immunocompromised status (HIV/AIDS or receiving immunosuppressive medications).
• Patients with granulocytopenia (< 1×10⁹/L).
• Patients with poorly controlled diabetes (HbA1c > 8%).
• History of gastrointestinal bleeding or active hemoptysis (at least half a teaspoon of bright red blood) within 3 weeks prior to the first dose of study medication.
• Patients with unexplained hypocalcemia.
• Patients with renal impairment (serum creatinine > 177 μmol/L or eGFR < 50 mL/min).
• Females who are breastfeeding or pregnant at screening or baseline.
• Currently enrolled in another clinical trial, or having received any investigational drug or device within 30 days prior to providing informed consent.

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