Pamidronate Treatment to Prevent Reoccurring Fractures in Children With Cerebral Palsy

Abstract

In patients with CP and disuse osteoporosis, the most common fracture sustained involved the distal femur via low-velocity injury, and most fractures were treated nonoperatively. Although the fracture pattern and the treatment remained unchanged, reoccurring fractures in these children can be effectively treated medically to interrupt the fracturing tendency.

Informing evidence‐based clinical practice guidelines for children with cerebral palsy at risk of osteoporosis: an update

“…The reviewed bisphosphonate studies are detailed in Table SIII (online supporting information). Two studies used intravenous pamidronate, and the third used intravenous zoledronic acid . Two of the studies were class III evidence supporting the use of bisphosphonate therapy for increased BMD .…”

“…Two class III studies demonstrated a decrease in fracture rate, but only one was statistically significant . One study demonstrated a trend in decreasing fragility fractures, as no new fractures were reported during the intervention period, but no statistical testing was done to measure the effect so it was downgraded to class IV support .…”

“…The included bisphosphonate studies also present methodological limitations that may have affected their outcomes. Two of the bisphosphonate studies were retrospective and measured the effect of bisphosphonates over 1 year . Considering the length of treatment, it is difficult to obtain significant results regarding the effect of bisphosphonates on fracture rate.…”

“…Two class III studies demonstrated a decrease in fracture rate, but only one was statistically significant. 5,6 One study What this paper adds • Updated systematic review and clinical practice guidelines for children with cerebral palsy at risk of osteoporosis.…”

Consensus guidelines on the use of bisphosphonate therapy in children and adolescents

“…18,27 Bisphosphonates increase BMD in children with CP, 2816,20,21 but there is a paucity of randomised controlled trials 18,19 and very limited data on the effect of bisphosphonates in reducing fracture risk. 17,29 A recent review concluded that bisphosphonates were probably effective at raising BMD and possibly effective at decreasing the fracture rate in this cohort. 30 Prophylactic bisphosphonate therapy (i.e.…”