The effect of intravenous zoledronic acid on glucocorticoid-induced multiple vertebral fractures in juvenile systemic lupus erythematosus

Abstract

Glucocorticoids are widely used in the treatment of lupus patients, and adverse effects, which include osteoporosis and associated fractures, are frequent. Treatment of osteoporosis of young patients should be effective and not harmful to bone growth and remodeling. Bisphosphonates are drugs that decrease the incidence of bone fractures, but their use in juvenile patients is still controversial because of their possible side effects on the growing skeleton. However, recently published studies showed that linear growth continued normally after treatment with these drugs, and there was no excessive suppression of bone remodeling or mineralization defects. Zoledronic acid is a new intravenous bisphosphonate that has been approved by the US FDA for use with hypercalcemia of malignancies and might be an effective treatment for postmenopausal osteoporosis. The authors report a case of a young girl with systemic lupus who developed multiple vertebral collapses due to glucocorticoid therapy, and zoledronic acid was used producing significant clinical and densitometric improvement.

Zoledronic acid for the treatment of osteopenia in pediatric Crohn's disease

“…The previous literature on the use of zoledronic acid in pediatrics is limited to a few cases series and short‐term uncontrolled studies, all of which demonstrate improved BMD compared to baseline 37–39 . As in adults, zoledronic acid was well tolerated in our study, although it is difficult to fully confirm its safety, given our small sample size.…”

“…19,36 The previous literature on the use of zoledronic acid in pediatrics is limited to a few cases series and short-term uncontrolled studies, all of which demonstrate improved BMD compared to baseline. [37][38][39] As in adults, zoledronic acid was well tolerated in our study, although it is difficult to fully confirm its safety, given our small sample size. Our study's dose of 0.066 mg/kg, with a maximum of 4 mg, was well tolerated despite other centres using a smaller dose, and there was no difference in the number of children with side effects in the two groups.…”