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Oral bisphosphonates to treat disuse osteopenia in children with disabilities: a case series
Maurice G Sholas1, Beverly Tann, Deborah Gaebler-Spira
1Pediatric Rehabilitation Program, Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, Northwestern University's Feinberg School of Medicine, 345 East Superior Street, Chicago, IL 60611, USA.
Insights
Oral alendronate may reduce fractures in nonambulatory children with disuse osteopenia. This study found that disabled children tolerated alendronate well, with significant fracture reduction and pain relief.
Area of Science:
- Pediatric Orthopedics
- Pharmacology
- Disability Studies
Background:
- Nonambulatory children with congenital conditions often experience pathologic fractures due to disuse osteopenia.
- Intravenous bisphosphonates are effective, but data on oral bisphosphonates for this population are lacking.
Purpose of the Study:
- To evaluate the safety and efficacy of oral alendronate in nonambulatory children with disuse osteopenia.
Main Methods:
- A case series of ten nonambulatory children with disuse osteopenia (due to static brain injury or spina bifida) treated with alendronate.
- Chart review to assess fracture incidence, pain, and medication tolerance.
Main Results:
- A significant reduction in fractures from 17 pre-treatment to 1 post-treatment.
- Resolution of pain and nociceptive behavior in all 5 affected children.
- Good gastrointestinal tolerance despite existing comorbidities, with only 1 discontinuation.
Conclusions:
- Oral alendronate appears to be well-tolerated and may reduce fracture incidence in disabled, nonambulatory children with severe disuse osteopenia.
Abstract:
Children with congenital conditions who are nonambulatory have been observed to have pathologic fractures due to disuse osteopenia. Data support the use of intravenous bisphosphonates to treat this in children with disabilities, but there are no data to guide the use of oral bisphosphonate medication. Ten nonambulatory children with disuse osteopenia secondary to either static brain injury or spina bifida were started on alendronate. Investigators completed a chart review of each subject. There were 17 fractures before starting alendronate and 1 fracture in the follow-up period. All children with nociceptive behavior or pain complaints (5/10) had their symptoms resolve after treatment. Despite the presence of gastrointestinal comorbidities (7/10 with a history of gastroesophageal reflux disease, 5/10 taking reflux medication, and 4/10 with PEG tubes), only 1 of the 10 children discontinued the medication secondary to gastrointestinal complaints. This case series offers evidence that disabled nonambulatory children tolerate alendronate, and it may decrease fractures in those at risk from severe disuse osteopenia.
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