Current Concept Review: The Role of Bisphophonates in Pediatric Orthopaedics: What do we know after 50 years?

Main Article Content

Jennifer C. Laine, MD
Allen Kadado, MD
Chrystina L. James, MD
Susan A. Novotny, PhD

Abstract

The first described case of bisphosphonate use in a pediatric patient was 50 years ago, in 1969.  Since then, bisphosphonates have been used for therapy in a wide variety of pediatric conditions, especially those of osteoporosis and bone fragility.  Bisphosphonates have become standard medical therapy for moderate and severe osteogenesis imperfecta, with studies consistently showing improvements in bone mineral density.  Despite the widespread use in this condition, there are no firm guidelines on treatment regimen or duration.   Bisphosphonates have also been explored in the therapy of pediatric secondary osteoporosis.  Although many studies have shown promising results, the evidence is not strong enough to inform clinical management conclusively.  Clinical study of bisphosphonate use in avascular necrosis has not been as promising as the data from preclinical, animal model work.  Although multiple studies have shown that bisphosphonate therapy improves pediatric bone mineral density, further study is needed to understand better the appropriate indications and treatment, as well as the clinical impact, including fracture reduction and effects on pain and quality of life.


Key Points



  1. Bisphosphonates are accepted therapy for moderate and severe osteogenesis imperfecta.  Studies consistently show improved bone mineral density, and many studies report decreased fracture risk.

  2. Small studies have shown improvements in bone mineral density in patients with secondary osteoporosis from cerebral palsy and with glucocorticoid-induced osteoporosis in Duchenne muscular dystrophy

  3. Clinical study of bisphosphonates for pediatric AVN of the hip is limited and does not currently support use to prevent femoral head deformity. Bisphosphonates may decrease pain in AVN.

  4. Short-term use of bisphosphonates is considered safe and well-tolerated in the pediatric population.  Long-term effects of bisphosphonate use remain unknown.

Article Details

Section
General Orthopedics