Background: On reviewing practical aspects of intravenous bisphosphonate use in our tertiary Childrens Hospital, we noted disparity between departments who prescribed these drugs. This included issues pertinent to patient safety and hospital management, e.g. the need for overnight admission for the first infusion, blood tests and monitoring for adverse events (AEs). We therefore decided to survey the practices of other tertiary Paediatric Endocrinology Centres.
Objective and hypotheses: To gather information on differences in practice when prescribing and administering intravenous bisphosphonates, in order to attempt to generate a consensus among paediatric endocrinologists in the UK.
Method: An online survey was sent to all members of the British Paediatric and Adolescent Bone Group (BPABG) with ten questions exploring how intravenous bisphosphonates are prescribed and monitored in their unit. Questions included choice of bisphosphonate, checking of blood tests, use of calcium supplementation and need for overnight admission after the first infusion. We received eighteen responses from twelve tertiary centres across the UK.
Results: All centres use Pamidronate, of whom 78% also use Zoledronic Acid. Over 89% check renal and bone profiles and vitamin D prior to infusions. 75% routinely prescribe calcium supplementation after Zoledronic Acid. Practices vary around infusion duration, overnight admission (61% admit children for the first infusion, 11% admit younger children, and 28% do not routinely admit) and post-infusion serum calcium monitoring (50% do not). Discussion indicated that anecdotal evidence of early AEs influenced practice. Further detail on occurrence, timing and severity of AEs would aim informed development of a consensus guideline.
Conclusion: Clinical governance around prescribing intravenous bisphosphonates in most UK Paediatric Endocrine units is good. However hospital admission remains a difficult issue and more evidence on occurrence, timing and severity of AEs of bisphosphonates is required, in order to generate a consensus on practicalities of their use.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology