Fracture during Intravenous Bisphosphonate Treatment in a Child with Osteogenesis Imperfecta: An Argument for a More Frequent, Low-Dose Treatment Regimen

Biggin, Andrew; Briody, Julie; Ormshaw, Elizabeth; Wong, Karen; Bennetts, Bruce; Munns, Craig F

doi:10.1159/000355111

Cited by 12 publications

(6 citation statements)

References 28 publications

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“…In the adult patient, due to the long‐acting nature of IV bisphosphonates, it is generally considered safe to delay treatment at least 6–9 months 82 . However, in children, ongoing new bone growth and the occurrence of stress risers in the setting of intermittent bisphosphonate administration may increase fracture risk if treatment is substantially delayed 83 . Consideration should be given to transitioning patients from pamidronate to zoledronic acid, which is infused over a shorter period of time and requires less frequent infusions.…”

Section: Management Of Endocrine Disorders In Children In the Covid Eramentioning

confidence: 99%

SARS‐CoV‐2 infection and paediatric endocrine disorders: Risks and management considerations

Ashraf

Gourgari

et al. 2021

Endocrino Diabet & Metabol

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Background Coronavirus‐19 (COVID‐19) is a disease caused by the SARS‐CoV‐2 virus, the seventh coronavirus identified as causing disease in humans. The SARS‐CoV‐2 virus has multiple potential pathophysiologic interconnections with endocrine systems, potentially causing disturbances in glucose metabolism, hypothalamic and pituitary function, adrenal function and mineral metabolism. A growing body of data is revealing both the effects of underlying endocrine disorders on COVID‐19 disease outcome and the effects of the SARS‐CoV‐2 virus on endocrine systems. However, comprehensive assessment of the relationship to endocrine disorders in children has been lacking. Content In this review, we present the effects of SARS‐CoV‐2 infection on endocrine systems and review the current literature on complications of COVID‐19 disease in underlying paediatric endocrine disorders. We provide recommendations on management of endocrinopathies related to SARS‐CoV‐2 infection in this population. Summary and outlook With the surge in COVID‐19 cases worldwide, it is important for paediatric endocrinologists to be aware of the interaction of SARS‐CoV‐2 with the endocrine system and management considerations for patients with underlying disorders who develop COVID‐19 disease. While children and adults share some risk factors that influence risk of complications in SARS‐CoV‐2 infection, it is becoming clear that responses in the paediatric population are distinct and outcomes from adult studies cannot be extrapolated. Evidence emerging from paediatric studies provides some guidance but highlights the need for more research in this area.

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Section: Management Of Endocrine Disorders In Children In the Covid Eramentioning

confidence: 99%

SARS‐CoV‐2 infection and paediatric endocrine disorders: Risks and management considerations

Ashraf

Gourgari

et al. 2021

Endocrino Diabet & Metabol

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“…As a result, long bone metaphyseal fractures have been reported post-bisphosphonate discontinuation, at the interface between the treated and treatment-naïve bone, in patients with open epiphyses and persistent osteoporosis risk factors (116). In fact, metaphyseal fractures have even occurred while receiving cyclical IV bisphosphonate therapy, at the interface between the dense metaphyseal lines created at the time of each cycle, and the adjacent, treatment-naïve bone (117). This begs the question as to whether IV bisphosphonates should be administered with as short an interval between infusions as possible, a consideration that is challenged by patient burden due to frequent infusions.…”

Section: Longitudinal Growth Influences the Duration Of Treatmentmentioning

confidence: 99%

Glucocorticoid-Induced Osteoporosis: Why Kids Are Different

Ward

2020

Front. Endocrinol.

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Glucocorticoids (GC) are an important risk factor for bone fragility in children with serious illnesses, largely due to their direct adverse effects on skeletal metabolism. To better appreciate the natural history of fractures in this setting, over a decade ago the Canadian STeroid-associated Osteoporosis in the Pediatric Population (“STOPP”) Consortium launched a 6 year, multi-center observational cohort study in GC-treated children. This study unveiled numerous key clinical-biological principles about GC-induced osteoporosis (GIO), many of which are unique to the growing skeleton. This was important, because most GIO recommendations to date have been guided by adult studies, and therefore do not acknowledge the pediatric-specific principles that inform monitoring, diagnosis and treatment strategies in the young. Some of the most informative observations from the STOPP study were that vertebral fractures are the hallmark of pediatric GIO, they occur early in the GC treatment course, and they are frequently asymptomatic (thereby undetected in the absence of routine monitoring). At the same time, some children have the unique, growth-mediated ability to restore normal vertebral body dimensions following vertebral fractures. This is an important index of recovery, since spontaneous vertebral body reshaping may preclude the need for osteoporosis therapy. Furthermore, we now better understand that children with poor growth, older children with less residual growth potential, and children with ongoing bone health threats have less potential for vertebral body reshaping following spine fractures, which can result in permanent vertebral deformity if treatment is not initiated in a timely fashion. Therefore, pediatric GIO management is now predicated upon early identification of vertebral fractures in those at risk, and timely intervention when there is limited potential for spontaneous recovery. A single, low-trauma long bone fracture can also signal an osteoporotic event, and a need for treatment. Intravenous bisphosphonates are currently the recommended therapy for pediatric GC-induced bone fragility, typically prescribed to children with limited potential for medication-unassisted recovery. It is recognized, however, that even early identification of bone fragility, combined with timely introduction of intravenous bisphosphonate therapy, may not completely rescue the osteoporosis in those with the most aggressive forms, opening the door to novel strategies.

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“…Due to the long-acting nature of intravenous bisphosphonates, it is typically regarded as safe to postpone therapy for at least 6–9 months in adults [ 124 ]. In youngsters, however, continued new bone formation and the emergence of stress risers during intermittent bisphosphonate medication may raise the risk of fracture if treatment is significantly delayed [ 125 ]. Consider switching patients from pamidronate to zoledronic acid, which is injected over a shorter time period and needs fewer infusions.…”

Section: Metabolic Bone Diseasementioning

confidence: 99%

Pediatric endocrinopathies related to COVID-19: an update

et al. 2022

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Background Coronavirus disease 2019 (COVID-19) is a disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the seventh coronavirus to be linked to human disease. The SARS-CoV-2 virus may have several pathophysiologic interactions with endocrine systems, resulting in disruptions in glucose metabolism, hypothalamus and pituitary function, adrenal function, and mineral metabolism. An increasing amount of evidence demonstrates both the influence of underlying endocrine abnormalities on the outcome of COVID-19 and the effect of the SARS-CoV-2 virus on endocrine systems. However, a systematic examination of the link to pediatric endocrine diseases has been missing. Data sources The purpose of this review is to discuss the impact of SARS-CoV-2 infection on endocrine systems and to summarize the available knowledge on COVID-19 consequences in children with underlying endocrine abnormalities. For this purpose, a literature search was conducted in EMBASE, and data that were discussed about the effects of COVID-19 on endocrine systems were used in the current study. Results Treatment suggestions were provided for endocrinopathies associated with SARS-CoV-2 infection. Conclusions With the global outbreak of COVID-19, it is critical for pediatric endocrinologists to understand how SARS-CoV-2 interacts with the endocrine system and the therapeutic concerns for children with underlying problems who develop COVID-19. While children and adults share certain risk factors for SARS-CoV-2 infection sequelae, it is becoming obvious that pediatric responses are different and that adult study results cannot be generalized. While pediatric research gives some insight, it also shows the need for more study in this area. Supplementary Information The online version contains supplementary material available at 10.1007/s12519-022-00662-x.

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Fracture during Intravenous Bisphosphonate Treatment in a Child with Osteogenesis Imperfecta: An Argument for a More Frequent, Low-Dose Treatment Regimen

Cited by 12 publications

References 28 publications

SARS‐CoV‐2 infection and paediatric endocrine disorders: Risks and management considerations

SARS‐CoV‐2 infection and paediatric endocrine disorders: Risks and management considerations

Glucocorticoid-Induced Osteoporosis: Why Kids Are Different

Pediatric endocrinopathies related to COVID-19: an update

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