Hypocalcemia following Neridronate Administration in Pediatric Patients with Osteogenesis Imperfecta: A Prospective
Evelina Maines1, Elisa Tadiotto2, Grazia Morandi3
1Pediatric Unit, Department of Women's and Children's Health, Provincial Centre for Rare Diseases, Azienda Provinciale per i Servizi Sanitari della Provincia Autonoma di Trento, Trento, Italy.
Insights
Intravenous bisphosphonates can cause hypocalcemia in pediatric osteogenesis imperfecta (OI) patients. Low baseline vitamin D levels are a significant risk factor for post-infusion hypocalcemia, necessitating treatment before neridronate administration.
Area of Science:
- Pediatric Endocrinology
- Bone Metabolism
- Pharmacology
Background:
- Intravenous bisphosphonates are used to treat osteogenesis imperfecta (OI).
- Hypocalcemia is a known complication of bisphosphonate therapy in OI patients.
- The incidence and risk factors for hypocalcemia following neridronate infusion in children require further investigation.
Purpose of the Study:
- To determine the incidence of hypocalcemia within 48 hours after neridronate infusion in pediatric OI patients.
- To explore correlations between baseline calcium, vitamin D, and bone turnover markers with post-infusion calcium levels.
- To identify predictive factors for hypocalcemia after neridronate treatment in children.
Main Methods:
- Prospective observational study involving 37 pediatric patients with OI.
- Single intravenous infusion of neridronate (1-2 mg/kg).
- Calcium, vitamin D, and bone turnover markers measured at baseline and at 24 (T24) and 48 (T48) hours post-infusion.
Main Results:
- Hypocalcemia occurred in 11% of patients at T24 and 50% at T48.
- A positive linear correlation was found between baseline vitamin D levels and post-infusion calcium levels (at T24 and T48).
- All cases of hypocalcemia were mild and asymptomatic.
Conclusions:
- Post-infusion calcium levels are significantly influenced by baseline vitamin D status.
- Low vitamin D levels are a key risk factor for hypocalcemia in pediatric OI patients receiving neridronate.
- Screening and correcting vitamin D deficiency before neridronate infusion is crucial to mitigate hypocalcemia risk.
Abstract:
The use of intravenous bisphosphonates has been linked to hypocalcemia both in children and adults with osteogenesis imperfecta (OI). The aims of this study were: (1) to investigate the incidence of hypocalcemia in the first 48 hours (T48) after neridronate infusion in a pediatric population with OI and (2) to assess any correlation between the baseline values of calcium, vitamin D (25-hydroxyvitamin D) and bone turnover markers, and the postinfusion calcium values. We conducted a prospective observational study on 37 pediatric patients. All patients were treated with a single infusion of neridronate at a dose of 1 to 2 mg/kg. The study provided two postinfusion reassessments: 24 hours (T24) and T48 after neridronate administration. Hypocalcemia was observed in 11% of patients at T24 and in 50% of patients at T48 from neridronate infusion. We observed a positive linear correlation between the baseline vitamin D values and postinfusion calcium values, both at baseline and at T24 and T48. Hypocalcemia was mild and asymptomatic in all cases. Postinfusion calcium levels were related to baseline vitamin D levels. Consequently, low vitamin D levels should be considered a significant risk factor for hypocalcemia and should be carefully investigated and treated before neridronate infusion.
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