Background: Bisphosphonates inhibit osteoclast activity, decreasing bone resorption and increasing bone mineral density (BMD). A Cochrane review in 2007 concluded further evidence is required for use of bisphosphonates in children with secondary osteoporosis.
Objective and hypotheses: We appraised our current practice of bisphosphonate use in children with secondary osteoporosis (as defined by the 2013 International Society for Clinical Densitometry Position Statement) or with low BMD and significant symptoms.
Method: 36 patients who were treated with bisphosphonates over a 7-year period were included. Data was collected on demographics, changes in BMD z-score, fractures rates and bone pain.
Results: 86% of patients had cerebral palsy or a neuromuscular condition and 14% had respiratory or endocrine disorders. The mean age of commencing treatment was 12.3 years and patients were followed up for an average of 46.3 months (range 796). Prior to treatment, the mean baseline BMD z-score was −3.0 (SEM±0.33). 95% of patients had long bone and/or vertebral fragility fractures and 39% of patients reported bone pain. 75% of patients received <2 years of bisphosphonate treatment and no patient received >5 years. The majority initially commenced Pamidronate but at completion of therapy, only 50% were on Pamidronate with 36% on Zoledronic Acid. Treatment was tolerated well in 72% of patients. Infrequent complications, including venous access issues, were reported in a minority. The mean BMD z-score was −2.2 (SEM±0.28), following an average treatment period of 16 (SEM±2.20) months. On follow up, 86% of patients had no fractures and 50% of patients commented on decreased pain.
Conclusion: Bisphosphonate use in a heterogeneous group of children with symptomatic low BMD or secondary osteoporosis resulted in increased bone density, and decreased fractures and pain. The treatment was well tolerated, and Zoledronic Acid is increasingly being used. Future prospective studies incorporating a larger cohort using quality of life data are needed.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology