The effect of low-dose intravenous bisphosphonate treatment on osteoporosis in children with quadriplegic cerebral palsy

Moon, Soon Jeong; An, Young Min; Kim, Soon Ki; Kwon, Young Se; Lee, Ji Eun

doi:10.3345/kjp.2017.60.12.403

Cited by 11 publications

(5 citation statements)

References 24 publications

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“…Therefore, calcium and vitamin D supplementation has become a widespread practice for preventing hypocalcemia during treatment with pamidronate [ 4 ]. Pamidronate treatment can cause an increase in 25(OH) 2 D 3 level and a decrease in alkaline phosphatase [ 27 ]; however, no significant changes in biochemical parameters were detected in the present study.…”

Section: Discussioncontrasting

confidence: 83%

“…Bone turnover markers can be helpful in monitoring the efficacy of treatment [ 29 ]. Previous studies have reported an increase in serum osteocalcin (which reflects increased bone formation) and a decrease in urine N-terminal telopeptide (which indicates decreased bone resorption) during pamidronate treatment [ 27 ]. However, no bone turnover markers were included in the present study due to lack of data.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of intravenous pamidronate infusion for treating osteoporosis in children and adolescents

Yoon

Choi

Lee

et al. 2021

Ann Pediatr Endocrinol Metab

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Osteoporosis is a skeletal disorder characterized by reduced bone mass that results in increased risk of fractures. Pediatric osteoporosis can be caused by monogenic diseases, chronic diseases, and/or their treatment. This study was performed to investigate the effect of pamidronate infusion on osteoporosis in children and adolescents. Methods: This study included 13 unrelated pediatric patients (10 males and 3 females) whose bone mineral density (BMD) z-score was <-2.0. Pamidronate was administered intravenously at a dosage of 1 mg/kg for 3 consecutive days every 4 months. Clinical and biochemical findings were reviewed retrospectively. The BMD values of the lumbar spine and femoral neck were assessed by dual energy x-ray absorptiometry at baseline and annually. Results: The underlying diseases were immobilization (62%), inflammatory bowel disease (23%), protein-losing enteropathy (8%), and idiopathic juvenile osteoporosis (8%). The mean age at the start of treatment was 12.7±4.3 years. Duration of treatment ranged from 12-50 months. The baseline height-standard deviation score (SDS) and weight-SDS were -2.01±2.08 and -2.60±1.62, respectively. The lumbar spine BMD z-scores improved significantly after 1 year of pamidronate treatment, but the femoral neck BMD z-scores did not. However, both z-scores had significantly increased by the end of treatment. Conclusion: This study demonstrated that pamidronate treatment increased BMD in pediatric patients with osteoporosis with no significant adverse events. Further studies are required to better define the long-term efficacy and safety of pamidronate therapy in a large number of pediatric patients.

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Section: Discussioncontrasting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of intravenous pamidronate infusion for treating osteoporosis in children and adolescents

Yoon

Choi

Lee

et al. 2021

Ann Pediatr Endocrinol Metab

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“…26) Several studies of secondary osteoporosis and bisphosphonate treatment have been conducted since 2002 (Supplementary Table 1). [13][14][15][16][17]27) In each study, patients received bisphosphonate treatments of various durations and dosages. The results of the studies showed that pamidronate could improve the BMD of patients with secondary osteoporosis and various underlying diseases.…”

Section: Discussionmentioning

confidence: 99%

“…Since bisphosphonates were first suggested as a treatment for primary osteoporosis in children with osteogenesis imperfecta in 1998, these therapies have been widely used as standard therapy for children with osteoporosis and pathologic fractures. 10) Previous studies have shown that bisphosphonates increase BMD [12][13][14][15][16] and decrease the risk of fractures in children with low BMD. 17) Many children with pathologic fractures have experienced improved disease conditions and quality of life after bisphosphonate treatment.…”

Section: Effectiveness and Safety Of Pamidronate Treatment In Nonambu...mentioning

confidence: 99%

Effectiveness and safety of pamidronate treatment in nonambulatory children with low bone mineral density

Lee,

Kwon,

Song

et al. 2024

Ann Pediatr Endocrinol Metab

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Purpose: Nonambulatory pediatric patients may have low bone mineral density (BMD) and increased risk of pathologic fractures. Though bisphosphonate therapy is the mainstream medical intervention in these children, clinical data regarding this treatment are limited. Therefore, this study aimed to evaluate the effectiveness and safety of bisphosphonate therapy in such children.Methods: We conducted a retrospective study of 21 nonambulatory children (Gross Motor Function Classification System level V) with BMD z-score ≤ -2.0 who were treated with intravenous pamidronate for at least 1 year. These patients received pamidronate every 4 months at a dose of 1.0 to 3.0 mg/kg for each cycle and had regular follow-ups for at least 1 year. The main outcome measures were changes in BMD, risk rate of fracture, biochemical data, and adverse events.Results: The average duration of pamidronate treatment was 2.0±0.9 years, and the mean cumulative dose of pamidronate according to body weight was 7.7±2.5 mg/kg/yr. After treatment, the mean lumbar spine bone mineral content, BMD, and height-for-age-z-score-adjusted BMD z-score (BMDhazZ) significantly improved. The relative risk of fracture after treatment was 0.21 (<i>p</i>=0.0032), suggesting that pamidronate treatment reduced fracture incidence significantly. The increase in the average dose per body weight in each cycle significantly increased the changes in BMDhazZ.Conclusion: Pamidronate treatment improved the bone health of nonambulatory children with low bone density without any significant adverse events. Independent of cumulative dosage and duration of treatment, the effectiveness of pamidronate increased significantly with an increase in the average dose per body weight in subsequent cycles.

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“…Pamidronate remains the most thoroughly investigated bisphosphonate for intravenous administration in children with fourteen studies (nine in children with CP) included in this review. Several studies used 15 mg/kg/year while the most recent studies document that dosages as low as 4.12 mg/kg/year 34 and 2.13–8.80 mg/kg/year 58 may be effective in children with CP. We were able to meta‐analyse five studies on children with CP who were treated with pamidronate.…”

Section: Discussionmentioning

confidence: 99%

Cerebral palsy and bisphosphonates – and what can be learned from other types of secondary osteoporosis in children: A scoping review

et al. 2023

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Aim:We aimed to improve bone health management of children with cerebral palsy (CP) by reviewing studies investigating bisphosphonate therapy in children with CP and other types of secondary osteoporosis. Methods:We included trials on bisphosphonate treatment reporting any direct bone measurement or fracture outcome. All studies of patients with CP were included.We also included all controlled trials of children with secondary bone fragility as well as observational studies with ≥20 participants or at least 3 years of follow-up.Studies were assessed according to PRISMA guidelines using the RoB2-tool and the Newcastle-Ottawa Scale. Results:We reviewed 1104 studies and found 37 eligible. Some studies were sufficiently homogeneous to include in a meta-analysis, and we found a 1-year effect on lumbar spine bone mineral density (BMD) Z-score of +0.65 after oral and + 1.21 after intravenous bisphosphonates in children with secondary osteoporosis. Further, data on adverse events and post-treatment follow-up were reviewed. Limitations were heterogeneity and small size of the included studies. Conclusion:Meta-analysis consistently showed significant BMD increases with bisphosphonates in children with secondary osteoporosis. Direct evidence of the effect of bisphosphonates on reducing fractures is lacking. We found no reports of longterm adverse events yet longer studies are needed.

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The effect of low-dose intravenous bisphosphonate treatment on osteoporosis in children with quadriplegic cerebral palsy

Cited by 11 publications

References 24 publications

Efficacy and safety of intravenous pamidronate infusion for treating osteoporosis in children and adolescents

Efficacy and safety of intravenous pamidronate infusion for treating osteoporosis in children and adolescents

Effectiveness and safety of pamidronate treatment in nonambulatory children with low bone mineral density

Cerebral palsy and bisphosphonates – and what can be learned from other types of secondary osteoporosis in children: A scoping review

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