Sustained beneficial effect of intravenous bisphosphonates after their discontinuation in children

Abstract

We studied if the beneficial effects of bisphosphonates are maintained after their discontinuation, and whether adverse effects may develop. Seventeen children in whom I.V. bisphosphonates were discontinued for at least 12 months were included. Fracture rate (FR), skeletal pain, bone mineral density of total body (TB) and spine L(2-4), skeletal radiographs, bone markers and kidney functions were compared between: (a) before treatment, (b) end of treatment, and (c) last follow-up. Mean treatment duration was 22+/-2 months (6-43) and follow-up 26+/-2 months (18-44). FR (mean +/- SD) decreased from 0.74+/-0.21/year before treatment to 0.35+/-0.11/year after treatment and 0.20+/-0.09/year at follow-up (p<0.05). Three children had bone pain before treatment, six during treatment and none at end of follow-up (p<0.05). TB Z-score increased from -1.24+/-0.50 at baseline to -0.37+/-0.44 at end of treatment and -0.39+/-0.37 at follow-up (p<0.05). Spinal Z-score increased from -1.65+/-0.57 to -0.34+/-0.56 and 0.19+/-0.49, respectively (p<0.05). Bone turnover markers showed sustained effect of bisphosphonates. No adverse effects on kidney functions or skeletal radiographs were noted. We conclude that I.V. bisphosphonates continue to exert their beneficial effect for a mean of 26+/-2 months after their discontinuation; therefore, once therapeutic goals are achieved, the medication can be withheld, followed by periodic re-evaluation.

Treatment of osteoporosis in children with glucocorticoid-treated diseases

“…Some studies have reported a trend toward an increase of height in children treated with intravenous bisphosphonates compared with pretreatment values [61,62].…”

Bisphosphonates for Pain Management in Children With Benign Cartilage Tumors

“…The treatment options with bisphosphonates and their potential side effects were discussed with the girl and her family as per our protocol. 11,17 After consenting, she received intravenous zoledronic acid 0.0125 mg/kg on day 1 and 0.025 mg/kg on day 2 followed 3 months later with 2 days of 0.025 mg/kg, after which she has been followed for 1 year. She has had no adverse effects to zoledronic acid therapy.…”

“…The treatment option with bisphosphonate and its potential side effects were discussed with the child and his family as per our protocol. 11,17 After consenting, he received pamidronate 0.75 mg/kg intravenously once daily on 2 successive days (described as a cycle). 17 He received another cycle 3 months and a year later.…”

“…11,17 After consenting, he received pamidronate 0.75 mg/kg intravenously once daily on 2 successive days (described as a cycle). 17 He received another cycle 3 months and a year later. He has had no adverse effects to pamidronate therapy.…”

Evaluation and comparison of safety, convenience and cost of administering intravenous pamidronate infusions to children in the home and ambulatory care settings

“…More specifi cally, pamidronate treatment has resulted in improved bone mineral density (6,7) and decreased fracture rate (8,9) and some of this effect appears to persist over time (10) . Pamidronate has a respectable safety record, with asymptomatic hypocalcemia being the most common side effect.…”