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Cyclical intravenous pamidronate treatment affects metaphyseal modeling in growing patients with osteogenesis
Christof Land1, Frank Rauch, Francis H Glorieux
1Genetics Unit, Shriners Hospital for Children and McGill University, Montreal, Québec, Canada.
Insights
Pamidronate treatment in children with osteogenesis imperfecta (OI) can alter bone shape, causing wider metaphyses. These changes appear to resolve over time without current clinical implications.
Area of Science:
- Pediatric Endocrinology
- Orthopedic Surgery
- Pediatric Rheumatology
Background:
- Cyclical intravenous pamidronate therapy benefits children with moderate to severe osteogenesis imperfecta (OI).
- Potential interference of pamidronate with long bone metaphysis shaping during growth is a concern.
Purpose of the Study:
- To evaluate the effects of pamidronate treatment on the distal femoral metaphysis shape in growing children with OI.
- To assess changes in metaphyseal index and the persistence of treatment-induced lines.
Main Methods:
- Analysis of distal femurs in 50 growing children with moderate to severe OI treated with pamidronate for 2-4 years.
- Radiographic measurement of growth plate and metaphysis width, and calculation of the metaphyseal index.
- Evaluation of pamidronate-induced transverse lines in metaphyses.
Main Results:
- Pamidronate-treated patients exhibited wider metaphyses, leading to a 26% higher metaphyseal index compared to untreated controls.
- Pamidronate cycles induced transverse lines in metaphyses, persisting for an average of 4 years.
- Growth plate width remained similar between treated and untreated groups.
Conclusions:
- Pamidronate disrupts periosteal resorption, affecting distal femoral metaphysis shaping in growing children with OI.
- Pamidronate-induced transverse lines represent horizontal trabeculae that remodel over time.
- Current evidence does not indicate clinical implications of these treatment-induced morphological changes.
Unlabelled:
This analysis of 50 growing patients with osteogenesis imperfecta revealed that 2-4 years of pamidronate treatment lead to abnormalities in the shape of the distal femoral metaphyses.
Introduction:
Cyclical intravenous pamidronate therapy is of clinical benefit in children and adolescents with moderate to severe osteogenesis imperfecta (OI) but might interfere with the shaping of long bone metaphyses during growth.
Materials And Methods:
We evaluated the distal femur in 50 growing children with moderate to severe OI (mean age, 6.7 +/- 3.4 years; 26 girls) who had received 2-4 years of pamidronate therapy (annual dose, 9 mg/kg body weight). The mediolateral width of the distal femoral growth plate and of the metaphysis, as well as the ratio between these two measures (called metaphyseal index), were determined on lower limb radiographs.
Results:
Compared with untreated OI patients who were matched for OI type and age, pamidronate-treated patients had similar growth plate width but wider metaphyses, resulting in a 26% higher metaphyseal index (p < 0.001). Apart from the effect on bone shape, each pamidronate cycle induces a transverse line in metaphyses that are adjacent to active growth plates. Analyses of these transverse lines revealed that they persist for an average time of approximately 4 years, with a range from 2 to 8 years.
Conclusions:
Pamidronate interferes with the process of periosteal resorption that is normally responsible for shaping the distal femoral metaphysis. Pamidronate-induced transverse lines disappear with time, supporting the view that these lines represent horizontal trabeculae that undergo remodeling. There is no evidence at present that these treatment induced morphological changes have any clinical implications.
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