Linear growth in children and adolescents treated with zoledronic acid (ZA): A Single Institution Case Series

Myrto Bonataki; Artemis Doulgeraki; Aikaterini-Kydonia Papadopoulou; Georgios Polyzois; Helen Athanasopoulou; Elpis-Athina Vlachopapadopoulou

P2-41

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ESPE Abstracts (2024) 98 P2-41

ESPE2024 Poster Category 2 Bone, Growth Plate and Mineral Metabolism (31 abstracts)

Linear growth in children and adolescents treated with zoledronic acid (ZA): A Single Institution Case Series

Myrto Bonataki ¹ , Artemis Doulgeraki ² , Aikaterini-Kydonia Papadopoulou ¹ , Georgios Polyzois ² , Helen Athanasopoulou ² & Elpis-Athina Vlachopapadopoulou ¹

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¹Department of Endocrinology-Growth and Development, "P. & A. Kyriakou" Children's Hospital, Athens, Greece. ²Department of Bone and Mineral Metabolism, Institute of Child Health, Athens, Greece

Introduction: Intravenously given bisphosphonates are the treatment of choice for pediatric osteoporosis. As bone resorption is an essential part of the normal endochondral ossification process, there were concerns on the possible negative impact of bisphosphonates on longitudinal growth during childhood. The aim of this study is to report the impact of zoledronic acid (ZA) on height in pediatric patients with primary osteoporosis.

Methods: The study population comprised children and adolescents with a recorded diagnosis of primary osteoporosis treated with ZA, for at least 1 year. Between November 2019 and April 2024, seven patients were treated with three-monthly infusions of ZA, at a dose of 0.025 mg/kg/infusion (total annual dose: 0.1 mg/kg). One patient was excluded from the analysis because of fused epiphyses (Table 1).

**Table 1:** Patient characteristics.
Case No	Sex	Age at baseline	Tanner stage at baseline	Onset of puberty	Clinical Diagnosis	Genetic analysis	Years of treatment
1	M	14y 1m	Stage III	Unknown	OI	yes	2.5
2	F	8y 11m	Stage I	10y 6m	OI	yes	2.7
3	M	13y	Stage IV	Unknown	LRP5 early-onset osteoporosis	yes	2.3
4	F	2y 7m	Stage I	-	OI	no	2.6
5	M	9y 6m	Stage I	10y 3m	OI	no	2
6	M	9y 11m	Stage I	11y	OPPG syndrome	yes	1
M: male, F: female, OI: osteogenesis imperfecta, LRP5: low density lipoprotein receptor-related protein 5, OPPG: osteoporosis–pseudoglioma

**Table 2:** Changes in HtSDS during ZA treatment. Height was converted to Ζ-scores according to the World Health Organization reference data.
Case No	Height at baseline		Height at 1 year		Annualized HV (first year)		Height at 2 years		Annualized HV (second year)
cm	Z-score	cm	Z-score	cm/y	Z-score	cm	Z-score	cm/y	Z-score
1	157.9	-0.76	168.9	-0.14	9.74	1.47	172.2	-0.15	3.53	0.42
2	119	-2.11	125.9	-1.86	7.17	0.78	132.8	-1.62	7.6	0.63
3	157	0.11	165.7	0.31	8.68	0.63	170.1	0.17	4.63	-0.22
4	88.5	-0.74	99	-0.33	9.3	-	106	-0.44	6.3	-
5	124.5	-1.80	130.8	-1.49	6.68	1.03	139.1	-1.03	8.3	1.51
6	136.7	-0.11	143.2	-0.05	5.67	0.12

Results/Conclusion: All patients showed a normal height velocity (HV) according to age and Tanner stage and achieved heights in the normal range (> -2 height standard deviation scores: Ht SDS) by the last visit (Table 2). In conclusion, the data from this small cohort show that children treated with regular ZA infusions have a normal growth rate.