ESPE Abstracts (2016) 86 P-P2-179

Bisphosphonate Use for Control of Chronic Severe Bone Pain in Children with Malignancy Associated Bone Involvement

Kriti Joshia,b & Margaret Zacharina,b


aRoyal Children’s Hospital, Melbourne, Victoria, Australia;
bMurdoch Children’s Research Institute, Melbourne, Victoria, Australia


Background: Bone involvement occurs commonly in pediatric malignancies, due to infiltration, metastasis or avascular necrosis. Pain is frequently chronic, debilitating, requires narcotic analgesia and can result in immobilization in bed or wheelchair. Intravenous bisphosphonates whilst primarily acting as osteoclast inhibitors also result in rapid and often complete pain relief in primary bone fragility disorders. When administered to children with malignant conditions affecting bone, significant improvement in pain, associated morbidity mobilization has been seen.

Objective and hypotheses: To describe results of use of zoledronic acid for management of bone pain in children with various malignant conditions.

Methods: Eleven children with chronic bone pain are described. Four had acute lymphoblastic leukaemia (ALL), 3 had acute myeloblastic leukaemia and 4 had metastatic neuroblastoma, rhabdomyosarcoma or hepatoblastoma. Six had glucocorticoid induced avascular necrosis (AVN) related to chemotherapy for haematological malignancies, four had widespread bony metastases from solid tumours and one had multiple vertebral fractures related to ALL but continuing long after remission. All received intravenous zoledronic acid 0.04 mg/kg 4 monthly for 12–24 months.

Results: Complete resolution of pain occurred in all after 1–2 infusions of zoledronic acid. No further analgesia was required. Mobility was restored in all and schooling resumed where appropriate. As previously reported, once bony collapse occurred in AVN, restoration of normal joints was impossible. Hip replacement was needed later in one. Death from malignancy occurred later in another.

Conclusion: Intravenous zoledronic acid administered in the setting of severe chronic bone pain associated with bony metastases, AVN or vertebral collapse in children and adolescents with malignancy results in sustained remission of bone pain, improved mobility and cessation of need for narcotic and other analgesia. This class of drug should be considered for management of malignancy related bone pain in children and adolescents.

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