Do Bisphosphonates Alleviate Pain in Children? A Systematic Review

Area of Science:

• Pediatric Rheumatology
• Oncology
• Pharmacology

Background:

• Bone pain significantly impacts children and adolescents with skeletal diseases.
• Bisphosphonates (BPs) are a class of drugs used to treat various bone conditions.
• The effectiveness of BPs for pain management in pediatric populations requires systematic evaluation.

Purpose of the Study:

• To systematically review the efficacy of bisphosphonates (BPs) in alleviating bone pain in pediatric patients with skeletal involvement.
• To analyze the available evidence on BP treatment for bone pain across diverse pediatric conditions.

Main Methods:

• A systematic review of 24 studies including randomized controlled trials, non-randomized controlled trials, and observational studies.
• Analysis of studies assessing pain intensity, with a focus on the use of validated pain assessment tools.
• Inclusion of studies evaluating BPs for conditions like osteogenesis imperfecta, osteoporosis, and cancer-related bone pain.

Main Results:

• Twenty out of 24 studies reported positive effects of BPs in reducing bone pain.
• The majority of studies assessed pain unidimensionally, and only 38% utilized validated pain assessment tools.
• A significant proportion (58%) of the included studies were categorized as having a high risk of bias.

Conclusions:

• Intravenous bisphosphonates appear beneficial for alleviating bone pain in children and adolescents.
• The current evidence is limited by heterogeneity in dosing, treatment duration, and pathologies, as well as a paucity of high-quality studies.
• Further rigorous research is essential to establish definitive guidelines for BP use in pediatric bone pain management.