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Published on: April 11, 2012
Delayed osteotomy but not fracture healing in pediatric osteogenesis imperfecta patients receiving pamidronate
Craig Fj Munns1, Frank Rauch, Leonid Zeitlin
1Genetics Unit, Shriners Hospital for Children, McGill University, Montréal, Québec, Canada.
Insights
Pamidronate treatment may delay osteotomy healing in children with osteogenesis imperfecta (OI). While it did not significantly affect fracture healing, improved mobility was linked to delayed fracture repair in OI patients.
Area of Science:
- Pediatric Orthopedics
- Bone Metabolism
- Pharmacology
Background:
- Osteogenesis imperfecta (OI) is a genetic disorder characterized by brittle bones.
- Pamidronate is a bisphosphonate commonly used to manage OI in children.
- The impact of pamidronate on bone healing in OI patients requires further clarification.
Purpose of the Study:
- To investigate the influence of pamidronate treatment on fracture and osteotomy healing in pediatric OI patients.
- To identify factors associated with delayed bone healing in this cohort.
Main Methods:
- Retrospective analysis of radiographic data from 197 lower limb fractures and 200 osteotomies in children with moderate to severe OI.
- Evaluation of bone healing, with delayed healing defined as incomplete union 12 months post-event.
- Statistical analysis to determine the association of pamidronate treatment, age, mobility, and fracture/osteotomy type with healing outcomes.
Main Results:
- Pamidronate treatment was associated with a higher incidence of delayed osteotomy healing.
- The association between pamidronate and delayed fracture healing was not significant after accounting for age.
- Better mobility status independently predicted delayed fracture healing during pamidronate treatment.
- Older age and tibial osteotomies were independent predictors of delayed healing during pamidronate therapy.
Conclusions:
- Pamidronate therapy appears to be associated with delayed healing of osteotomy sites in children with OI.
- Pamidronate treatment did not show a significant association with delayed fracture healing.
- Mobility status is a key factor influencing fracture healing in OI patients undergoing pamidronate treatment.
Unlabelled:
This study evaluated factors influencing fracture (n = 197) and osteotomy (n = 200) healing in children with moderate to severe OI. Pamidronate treatment was associated with delayed healing after osteotomy, but not after fracture. The data suggest that both pamidronate and mechanical factors influence bone healing in this cohort.
Introduction:
Intravenous pamidronate is widely used to treat children with moderate to severe osteogenesis imperfecta (OI). However, the effect of this treatment on bone healing is not well characterized. We therefore retrospectively analyzed the healing of lower limb fractures and osteotomies in children with moderate to severe OI, both before and after the start of pamidronate treatment.
Materials And Methods:
Bone healing was evaluated on standard radiographs after 197 lower limb fractures (132 femur and 65 tibia) in 82 patients (age at fracture, 0.0-19.9 years) and 200 intramedullary rodding procedures in 79 patients (age at surgery, 1.2-19.8 years). Delayed healing was diagnosed when a fracture or osteotomy line was at least partially visible 12 months after the event.
Results:
Delayed fracture healing was observed more frequently during than before pamidronate treatment. However, the effect of pamidronate was no longer significant when age differences were taken into account (odds ratio [OR], 1.76; 95% CI, 0.61-5.10). Better mobility status was a strong independent predictor of delayed healing after fractures that occurred during pamidronate treatment. After osteotomies, delayed healing was more frequent when pamidronate had been started before surgery (OR, 7.29; 95% CI, 2.62-20.3), and this effect persisted after adjustment for multiple confounders. During pamidronate treatment, older age (OR per year of age, 1.25; 95% CI, 1.06-1.47) and osteotomy of the tibia (OR, 3.51; 95% CI, 1.57-7.82) were independent predictors of delayed healing.
Conclusions:
This study suggests that pamidronate therapy is associated with delayed healing of osteotomy sites after intramedullary rodding procedures. Better mobility status, but not pamidronate treatment, seems to be predictive of delayed healing after fractures.
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