Use of bisphosphonates in children and adolescents

The bisphosphonates are chemically simple compounds that have been used mainly for the treatment of osteoporotic conditions and for hypercalcaemia. They have had relatively limited use in children. Their action is principally to interfere with the activity of osteoclasts by causing apoptosis. Their use in children has been for problems of soft tissue calcification (e.g. idiopathic arterial calcification, myositis ossificans progressiva and dermatomyositis), hypercalcaemia (e.g. caused by malignancy, immobilisation or hyperparathyroidism), generalised bone disease (e.g. osteogenesis imperfecta, idiopathic juvenile osteoporosis and steroid-induced osteoporosis) and localised bone disease (e.g. Gaucher's disease and McCune-Albright syndrome). In general they cause few short-term side effects although the long-term side effects have yet to be determined, but are probably relatively unimportant. The bisphosphonates are likely to prove a useful addition to the armamentarium of treatment modalities for bone disease in children.