Full Length ArticleOutcomes following intravenous bisphosphonate infusion in pediatric patients: A 7-year retrospective chart review
Section snippets
Background
Low bone mineral density and fractures are increasingly recognized as complications of chronic pediatric medical conditions. Impaired mobility, chronic inflammation, inadequate nutrition, hormone disruption, and medication use (e.g., glucocorticoids, anti-epileptics and immunosuppressive agents) are all factors that affect bone size and microarchitecture and impair bone mineralization in children with chronic disease, potentially leading to the diagnosis of osteoporosis [1]. Treatment is first
Study design
We conducted a retrospective chart review of patients < 21 years of age at initiation of IV BP therapy for treatment of osteoporosis at a large tertiary medical center (Cincinnati Children's Hospital Medical Center). We utilized the electronic medical records (EMR) to identify all instances of intravenous pamidronate (PAM) or zoledronic acid (ZA) infusion at our hospital between January 2010 and July 2017. A total of 1141 infusions from 169 unique patients were reviewed. Our aim was to study
Patients characteristics
One hundred twenty-three patients (56% male) were followed for an average of 3.8 years following first IV BP infusion at CCHMC. One hundred patients (81%) met the ISCD criteria for the diagnosis of pediatric osteoporosis. Eight patients (7%) had low BMD with a history of one long bone fracture prior to IV BP infusion. The remaining 15 patients (12%) were started on bisphosphonate therapy without a history of fragility fracture prior to first IV BP. The decision to initiate treatment in these
Discussion
Favorable efficacy and safety profiles for IV BP therapy have been well described in patients with primary osteoporosis; however, less is known about the safety and efficacy of IV BPs in children with secondary osteoporosis or GIO. This study reviewed the use of IV BP therapy at a tertiary care center in a diverse cohort of patients with impaired bone mineralization. We aimed to add to the available literature on the safety and efficacy in children with secondary bone disease. In our cohort,
Conclusion
In pediatric patients with osteoporosis, adverse events due to IV BP treatment were mild and generally would not require inpatient management. APR and electrolyte abnormalities were more likely to occur in patients with secondary osteoporosis, a group who may require closer monitoring. Long-term serious adverse events including ONJ and AFF were not identified in 468 patient years of monitoring our cohort. IV BP treatment increased aBMD of trabecular bone but change in LS aBMD Z-score at one
Funding
No external funding.
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