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Pamidronate treatment of pediatric fracture patients on chronic steroid therapy

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Abstract

Pediatric nephrology and rheumatology patients with steroid-induced osteopenia are at risk of skeletal fracture. Bisphosphonate therapy has not been routinely advocated as a primary or secondary intervention for steroid-associated fractures in this population. This case control study evaluates the role of pamidronate therapy as a secondary fracture intervention. Children with symptomatic pathological fractures of the axial spine or ribs were treated with pamidronate 1 mg/kg/dose (n=17) IV at 60-day intervals for 1 yr (n=15) or 2 yr (n=2). Bone mineral density of L1–L4 (BMD) was assessed prior to treatment and at six-month intervals, and compared to 17 disease-age-gender-steroid dose-matched control patients. Alkaline phosphatase, calcium, phosphate, PTH, renal biochemistry, and 24-hr urine collections for CrCl, N-telopeptide/creatinine ratio, phosphate excretion, and calcium excretion were obtained every two months in the pamidronate population. Pamidronate caused a first exposure transient flu-like illness lasting <24 h in three patients and one patient had a new pathological fracture. No adverse events of hypocalcemia, allergic reaction or thrombophlebitis were noted. All patients reported improvement of skeletal pain. Despite ongoing steroid treatment, pamidronate significantly increased L1–L4 BMD Z-scores (mean±SE) relative to baseline (pamidronate vs control: 0–6 months: 0.27±0.14 vs −0.82±0.31; 0–12 months: 0.63±0.17 vs −0.46±0.27; 0–18 months: 0.55±0.32 vs 0.17±0.27; 0–24 months: 0.15±0.21 vs −0.23±0.22; 0–30 or 36 months: 0.77±0.71 vs −0.68±0.25) with repeated measures ANOVA assessment (F=11.27, p=0.0057). This study supports the safety and efficacy of pamidronate in steroid-induced fractures in pediatric nephrology and rheumatology patients.

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Authors and Affiliations

  1. Department of Pediatrics, Dalhousie University, 5850 University Avenue, Halifax, Nova Scotia, B3J 3G9, Canada

    Philip D. Acott, Bianca A. Lang & John F. S. Crocker

  2. Department of Pharmacology, Dalhousie University, 5850 University Avenue, Halifax, Nova Scotia, B3J 3G9, Canada

    Philip D. Acott

  3. Department of Urology, Dalhousie University, 5850 University Avenue, Halifax, Nova Scotia, B3J 3G9, Canada

    Jaime A. Wong

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  1. Philip D. Acott
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  2. Jaime A. Wong
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  3. Bianca A. Lang
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  4. John F. S. Crocker
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Correspondence to Philip D. Acott.

Additional information

This study was presented in part at the IPNA Seventh Symposium of Growth and Development in Children with Chronic Kidney Disease: The Molecular Basis of Skeletal Growth, 1–3 April 2004, Heidelberg, Germany

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Acott, P.D., Wong, J.A., Lang, B.A. et al. Pamidronate treatment of pediatric fracture patients on chronic steroid therapy. Pediatr Nephrol 20, 368–373 (2005). https://doi.org/10.1007/s00467-004-1790-8

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  • DOI: https://doi.org/10.1007/s00467-004-1790-8

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