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Review
. 2014 May;6(5):427-36.
doi: 10.1016/j.pmrj.2013.10.009. Epub 2013 Dec 22.

Bisphosphonate treatment for children with disabling conditions

Alison M Boyce  1 , Laura L Tosi  2 , Scott M Paul  3
Affiliations
Review

Bisphosphonate treatment for children with disabling conditions

Alison M Boyce et al. PM R. 2014 May.

Abstract

Fractures are a frequent source of morbidity in children with disabling conditions. The assessment of bone density in this population is challenging, because densitometry is influenced by dynamic forces affecting the growing skeleton and may be further confounded by positioning difficulties and surgical hardware. First-line treatment for pediatric osteoporosis involves conservative measures, including optimizing the management of underlying conditions, maintaining appropriate calcium and vitamin D intake, encouraging weight-bearing physical activity, and monitoring measurements of bone mineral density. Bisphosphonates are a class of medications that increase bone mineral density by inhibiting bone resorption. Although bisphosphonates are commonly prescribed for treatment of adult osteoporosis, their use in pediatric patients is controversial because of the lack of long-term safety and efficacy data.

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Figures

Figure 1
Figure 1
Chemical structure of pyrophosphate (A) and bisphosphonates (B). P = phosphorus, O = oxygen, H = hydrogen, C = carbon, R = side chain.
Figure 2
Figure 2
Images depicting sclerotic bands associated with bisphosphonate treatment. (A) A 10-year-old girl with fibrous dysplasia who was treated with a 3-year course of pamidronate was found to have transverse sclerotic bands at the radial epiphysis and metaphysis (arrow). Note the expansile, ground glass appearance of the fibrous dysplasia in her metacarpals and phalanges (arrowheads). (B) Radiographs from a 13-year-old boy with osteogenesis imperfecta who was treated with pamidronate for 2 years demonstrate metaphyseal bands in the distal femur and proximal tibia (arrows). An intramedullary rod has been placed for fixation of a femoral fracture (arrowhead). (C) A 13-year-old girl with fibrous dysplasia underwent a 1-year course of pamidronate at age 7 years, which caused residual sclerotic bands that appear to have migrated toward the tibial diaphysis with continued skeletal growth (arrow). (D) Spine films from the patient in (C) demonstrate sclerosis at the superior and inferior end plates of the vertebral bodies (arrows).
See this image and copyright information in PMC

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