Drugs Used in Paediatric Bone and Calcium Disorders

Abstract

Calcium and bone disorders in children and adolescents are treated with a wide variety of drugs. Several of these drugs have been used for many years on the basis of accepted practice, without being subjected to rigorous trials. Bisphosphonates are the mainstay treatment for children with osteoporosis, but newer, more potent compounds such as zoledronate and risedronate have begun to replace the older-generation bisphosphonates. Hypocalcaemia is managed with calcium and vitamin D and its metabolites. In difficult cases that are secondary to hypoparathyroidism, subcutaneous injections or infusions of parathyroid hormone have been used. Multiple daily phosphate supplements and calcitriol are the standard treatment for hypophosphataemic rickets, but trials of an anti-fibroblast growth factor 23 antibody appear promising, and the results are eagerly awaited. Many new medications are undergoing clinical trials and are starting to emerge as viable treatment options for children. Some of these drugs target specific diseases, such as recombinant alkaline phosphatase for hypophosphatasia and a C-type natriuretic peptide analogue for achondroplasia. Other drugs, such as denosumab and odanacatib, have been used successfully in the adult population, and the appropriate use of these drugs in children is now being evaluated.

Once‐monthly Oral Ibandronate Treatment in an Adolescent With Recurrent Fractures and Inadequately Low Bone Mass

“…In children with low BMD and a history of fractures, bisphosphonates are being administered with increasing frequency as off‐label drugs. Bisphosphonates, although not licensed for use in children, are nevertheless used in paediatrics on the basis of accepted practice 3 . There have been reports of intravenous administration of pamidronate, neridronate or zoledronate, or oral alendronate or olpadronate to children with either osteogenesis imperfecta or secondary osteoporosis, with favourable outcomes 3–6 .…”

“…Bisphosphonates, although not licensed for use in children, are nevertheless used in paediatrics on the basis of accepted practice 3 . There have been reports of intravenous administration of pamidronate, neridronate or zoledronate, or oral alendronate or olpadronate to children with either osteogenesis imperfecta or secondary osteoporosis, with favourable outcomes 3–6 . Short‐term (3 years or less) bisphosphonate use appears to be well tolerated and safe 3–6 .…”

“…There have been reports of intravenous administration of pamidronate, neridronate or zoledronate, or oral alendronate or olpadronate to children with either osteogenesis imperfecta or secondary osteoporosis, with favourable outcomes 3–6 . Short‐term (3 years or less) bisphosphonate use appears to be well tolerated and safe 3–6 . However, the use of bisphosphonates in paediatric patients remains controversial because of lack of placebo‐controlled clinical trials and safety data 4 .…”

Unusual haematologic manifestations of Mycoplasma pneumoniae infection

“…Bisphosphonates, although not licensed for use in children, are nevertheless used in paediatrics on the basis of accepted practice. 3 There have been reports of intravenous administration of pamidronate, neridronate or zoledronate, or oral alendronate or olpadronate to children with either osteogenesis imperfecta or secondary osteoporosis, with favourable outcomes. 3-6 Short-term (3 years or less) bisphosphonate use appears to be well tolerated and safe.…”

“…3-6 Short-term (3 years or less) bisphosphonate use appears to be well tolerated and safe. [3][4][5][6] However, the use of bisphosphonates in paediatric patients remains controversial because of lack of placebo-controlled clinical trials and safety data. 4 Therefore, many experts recommend limiting use of these agents to those children with recurrent extremity fractures, symptomatic vertebral collapse and reduced bone mass.…”