Consensus guidelines on the use of bisphosphonate therapy in children and adolescents

Abstract

Bisphosphonate therapy is the mainstay of pharmacological intervention in young people with skeletal fragility. The evidence of its use in a variety of conditions remains limited despite over three decades of clinical experience. On behalf of the Australasian Paediatric Endocrine Group, this evidence-based consensus guideline presents recommendations and discusses the graded evidence (using the GRADE system) for these recommendations. Primary bone fragility disorders such as osteogenesis imperfecta are considered separately from osteoporosis secondary to other clinical conditions (such as cerebral palsy, Duchenne muscular dystrophy). The use of bisphosphonates in non-fragility conditions, such as fibrous dysplasia, avascular necrosis, bone cysts and hypercalcaemia, is also discussed. While these guidelines provide an evidence-based approach where possible, further research is required in all clinical applications in order to strengthen the recommendations made.

Bone morbidity in pediatric acute lymphoblastic leukemia

“…7) Osteoporosis originating from ALL is triggered by multiple factors, including leukemic infiltration of bone, reduced bone strength due to immobility, poor growth induced by nutritional deficiency, and the use of various osteotoxic drugs. 8) This review addresses bone morbidity after pediatric ALL treatment and provides an overview of bone pathology based on skeletal outcomes to increase awareness among pediatric hemato-oncologists and endocrinologists.…”

Bisphosphonates in pediatric rheumatology: A review

“…In general, Zoledronic acid 0.1 mg/kg/year in 2 divided doses or Pamidronate 9 mg/kg/ year in 4-6 divided doses is recommended. The recommended dose range for Intravenous Pamidronate is 0.5-1.5 mg/kg/day for 3 days every 2-6 months and for Alendronate is 1-2 mg/kg/week orally for a total duration of 12 months [5,6]. However, there are no established guidelines for the most appropriate dosing regimen and agent for secondary osteoporosis in Pediatrics.…”

“…Studies in children show that bisphosphonates do not reduce bone growth, trabecular bone formation or periosteal bone formation (modelling). Reduced bone resorption and ongoing bone growth and modelling results in the significant increase in bone mass and strength observed when bisphosphonates are administered to the growing child [5].…”

“…Other bisphosphonate preparations with their doses and routes of administration [5,6] are listed in Table 1.…”

“…Recent consensus guidelines published by the Australasian pediatric endocrine group (APEG) [5] for use of bisphosphonates in children include recommendations for monitoring of side effects.…”