ESPE Abstracts

Intravenous pamidronate is the most commonly prescribed bisphosphonate in pediatrics and most data on efficacy and safety of pamidronate comes from studies on Osteogenesis imperfecta. We describe a case of a 14-year-old boy who presented with steroid induced osteoporosis. He had been taking Solondo (Prednisolone) and Methotrexate for rheumatoid arthritis since the age of 4, and he was experiencing severe short stature and bone pain. He was unable to ambulate independently due to severe lumbar and leg pain, necessitating the use of a wheelchair for mobility. His BMD using Dual Energy X-ray Absorptiometry (DEXA) showed severe osteoporosis [femoral neck Z-score -3.4, TBLH (Total Body Less Head) Z score – 4.3). The radiographic bone age corresponds to the 12 years 6 months old. All PIP (Proximal Interphalangeal joint) had deformity with flexion and erosions. The growth hormone stimulation test conducted to exclude growth hormone deficiency was normal. He showed pituitary hypoplasia (height of pituitary gland (maximum 3.3-mm) and concave appearance of superior surface). He received intravenous pamidronate at a dose of 0.5 mg / kg every six weeks for a total of eight infusions. Following the treatment, there was no significant change in his bone mineral density (BMD); however, his bone pain improved, allowing him to walk without a wheelchair. In conclusion, intravenous administration of pamidronate for steroid-induced osteoporosis in a patient with rhematic arthritis resulted in significant improvement of severe bone pain.