Use of bisphosphonates in a case of Perthes disease

Bisphosphonates are a group of drugs that have been used extensively for more than 10 years to treat adults with osteoporosis. Use of bisphosphonates in pediatrics has generally been confined to conditions such as osteogenesis imperfecta or other conditions with bone density problems. Bisphosphonates increase bone density, bone mineral content, and strength; improve mobility; reduce fracture rates; and are effective agents in combating bone pain. Bisphosphonates inhibit osteoclastic action, thereby increasing bone density (Rauch & Glorieux 2004). Recently there has been interest in the effect of bisphosphonates in localized disorders of bone, including avascular necrosis. The third-generation bisphosphonate zoledonic acid is currently being explored as a treatment for children presenting with Perthes disease at the Children's Hospital at Westmead, Sydney, Australia, and this is a report of that experience.