Bone densitometry in pediatric patients treated with pamidronate

Area of Science:

• Pediatric Endocrinology
• Pediatric Orthopedics
• Pediatric Rheumatology

Background:

• Bisphosphonate therapy, specifically pamidronate, is increasingly used for pediatric low bone mineral density.
• Children at high risk for fractures due to bone disorders or limited mobility are primary candidates for this treatment.

Purpose of the Study:

• To evaluate the efficacy of intravenous pamidronate in enhancing bone mineral density (BMD) in pediatric patients.
• Specifically assessed outcomes in children diagnosed with osteogenesis imperfecta (OI) and spastic quadriplegic cerebral palsy (CP).

Main Methods:

• Retrospective chart review of 38 children (20 with OI, 18 with CP) treated with pamidronate.
• Patients selected based on prior fractures or significantly low BMD.
• Treatment involved intravenous pamidronate administered every 2-8 months, with BMD assessed via dual-energy X-ray absorptiometry (DXA).

Main Results:

• Significant BMD improvements were observed in 31 of 32 patients.
• Average BMD increase was 78% in OI and 47.4% in CP patients at the lumbar spine.
• Femur BMD increased by 96% in OI and 65.7% in CP patients, exceeding age-expected growth.
• Children with CP ceased fracturing after treatment initiation; OI patients had a reduced fracture rate.

Conclusions:

• Intravenous pamidronate is effective for increasing BMD in pediatric patients with OI and CP.
• While both groups showed BMD gains, OI patients continued to fracture less frequently.
• Children with CP experienced significant BMD increases and fracture cessation.