Complications of pamidronate therapy in paediatric osteoporosis

Abstract

Purpose Pamidronate, used for the treatment of paediatric osteoporosis, reduces the fracture rate and improves ambulatory status. Intravenous pamidronate therapy has known complications which have not been stratified based on its dose and distribution. This study aims to assess the early minor and major medical and late surgical complications and the effect of the dose and regimen of infusion on these events in paediatric osteoporosis. Study design Retrospective cohort. Materials and methods Three regimens for pamidronate infusion were followed in sequential periods in 10 years. Regimen A delivered 1.5 mg/kg/day as a single dose once in 3 months. Regimen B delivered 2 mg/kg/day for 3 days twice a year, while regimen C delivered 1 mg/kg/day for 3 days every 3-4 months. Adverse events were classified as early (major and minor) or late (surgical). Results Forty-eight children received 158 infusions using one of the three regimens. Twenty-nine complications occurred in 24 children. A significant difference in the complication rate was present among the three regimens (P = 0.005). Nineteen children had minor complications, mainly febrile reaction or asymptomatic hypocalcaemia. Four major complications consisting of one seizure, one respiratory distress and two hypocalcaemic tetany were encountered, all with regimen B. Intraoperative complication faced was loss of position due to splintering of the cortex while rush rodding. This was seen in 20% of the long bone segments operated in those who received pamidronate as compared to 4.4% of the segments which were operated prior to the initiation of pamidronate therapy; the odds of splintering were 5.4 times higher for those patients who were bone segment rodded after pamidronate therapy. Discussion Intravenous pamidronate is associated with complications in 50% of children with paediatric osteoporosis, with a dose-dependent significant difference. Major complications are not uncommon with higher doses and can be avoided by increasing the number of doses per year and decreasing the dose per cycle. Surgical difficulty, when possible, can be avoided by correcting any major deformities at presentation prior to the induction of pamidronate therapy.

Hypocalcemia following Neridronate Administration in Pediatric Patients with Osteogenesis Imperfecta: A Prospective Observational Study

“…17 The use of IV BPs has been linked to hypocalcemia both in children and adults, [17][18][19][20] but only few studies have been conducted in patients with OI. [21][22][23][24][25][26][27][28][29] In the literature, there is only one study reporting the risk of hypocalcemia in OI patients treated with neridronate. Gatti et al assessed serum calcium levels 3 to 7 days after the neridronate infusion, observing calcium values ranging from 8.1 to 9.2 mg/dL (normal range, 8.5-10.2 mg/dL).…”

Effects of Pamidronate Administration on Tooth Eruption and Mandibular Growth in New Born Rats

“…It improves ambulatory status and increases the growth rate. In addition, increases in bone mineral density and vertebral height have been reported (8)(9)(10). There are few published animal studies regarding effects of BPs on mandibular development and tooth eruption (1,2,11).…”

“…It improves ambulatory status and increases the growth rate. In addition, increases in bone mineral density and vertebral height have been reported ( 8 , 9 , 10 ).…”

Effects of Pamidronate on Dental Enamel Formation Assessed by Light Microscopy, Energy-Dispersive X-Ray Analysis, Scanning Electron Microscopy, and Microhardness Testing

“…This is possibly the reason for few reports on human dental alterations as a consequence of etidronate use (Iwai et al, 2013). Alendronate, pamidronate, and zoledronate are certainly the most clinically important BPs in dentistry as they are widely prescribed for children under treatment of a variety of bone diseases, especially OI (Glorieux et al, 1998;Plotkin et al, 2000;Maasalu et al, 2003;Bajpai et al, 2007;Kamoun-Goldrat et al, 2008;Phillipi et al, 2008;Bachrach & Ward, 2009;Castillo & Samson-Fang, 2009;Hiraga et al, 2010;August et al, 2011;Kitaoka et al, 2011;Ward et al, 2011;Barros et al, 2012;Chilbule & Madhuri, 2012;Bishop et al 2013;Sukumar et al, 2013;Baroncelli & Bertelloni, 2014;Dwan et al, 2014). Pamidronate and zoledronate are NBPs with a mechanism of action on bone matrix and cells similar to that exhibited by alendronate.…”