http://austinpublishinggroup.com/pediatrics-child-health-care/
Controversy surrounds the optimal agent,
dose and duration of bisphosphonate therapy for pediatric osteoporosis. We
conducted a prospective, observational study of low-dose (4 mg/kg/year)
intravenous pamidronate in 31 children with Osteogenesis Imperfecta (OI) or
non-OI osteoporosis treated for a median of 39 months (range 6.5-164). Subjects
in both diagnostic groups showed significant gains in spine areal Bone Mineral
Density (aBMD) during the first year of therapy (29% median gain in children
with OI and 15% in children with non-OI osteoporosis). Fracture frequency also
declined significantly in both patient groups during the first year of
treatment, including for two patients who had <10% improvement in spine aBMD
over this time frame. The correlation between % change in aBMD and % change in
fracture rate for our study population was weak, as demonstrated by a
Spearman’s rank correlation coefficient (rho) of 0.13 (p-value 0.32, 95%
confidence interval -0.32 to 1.00). Minor side effects of bisphosphonate
therapy were self-limited, and no osteopetrosis, jaw osteonecrosis, or atypical
femur fractures occurred during treatment for up to 13.6 years. These data
suggest that low dose pamidronate is safe and effective for long-term use in
pediatric osteoporosis, and that change in aBMD is an imperfect predictor of
reduction in fracture risk.
Bone fragility and
osteoporosis (OP) are common complications of several genetic and acquired
disorders of childhood. Pediatric patients with Osteogenesis Imperfecta (OI),
inflammatory bowel disease, rheumatologic disorders, cerebral palsy, muscular
dystrophy, cystic fibrosis, or a history of transplantation may develop low
bone mass and fragility fractures. Treatment of pediatric osteoporosis
begins with optimizing nutrition, vitamin D stores, endocrine function, and
weight-bearing physical activity. When these measures are insufficient to
prevent bone loss and fracture, use of pharmacologic therapies is considered.
Pharmacologic
options for treating OP in adults include bisphosphonates to reduce bone
resorption and anabolic agents to stimulate bone formation. The safety and
efficacy of these medications in older patients have been established in large
randomized controlled trials (RCTs), but data are limited in pediatrics.
The best studied anabolic agent, synthetic parathyroid hormone, should not be
used in children due to a black box warning about the risk of osteosarcoma.
The anti-resorptive bisphosphonates have been used to treat primary and
secondary osteoporosis in children, but the optimal agent, dose and duration of
therapy remain controversial due to a lack of RCTs comparing different drugs
and dosing regimens.
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