Korean J Pediatr.  2017 Dec;60(12):403-407. 10.3345/kjp.2017.60.12.403.

The effect of low-dose intravenous bisphosphonate treatment on osteoporosis in children with quadriplegic cerebral palsy

• Moon SJ
• An YM
• Kim SK
• Kwon YS
• Lee JE

• KMID: 2398889
• DOI: http://doi.org/10.3345/kjp.2017.60.12.403

Abstract

PURPOSE
Quadriplegic children with cerebral palsy are more susceptible to osteoporosis because of various risk factors that interfere with bone metabolism. Pamidronate is effective for pediatric osteoporosis, but there are no guidelines for optimal dosage or duration of treatment in quadriplegic children with osteoporosis. We aimed to evaluate the efficacy of low-dose pamidronate treatment in these patients.
METHODS
Ten quadriplegic patients on antiepileptic drugs (6 male, 4 female patients; mean age, 10.9±5.76 years), with osteoporosis and gross motor function classification system level V, were treated with pamidronate (0.5-1.0 mg/kg/day, 2 consecutive days) every 3-4 months in a single institution. The patients received oral supplements of calcium and vitamin D before and during treatment. The lumbar spine bone mineral density (BMD) z score and biochemical markers of bone metabolism were measured regularly during treatment.
RESULTS
The main underlying disorder was perinatal hypoxic brain damage (40%, 4 of 10). The mean cumulative dose of pamidronate was 4.49±2.22 mg/kg/yr, and the mean treatment period was 10.8±3.32 months. The BMD z score of the lumbar spine showed a significant increase from −4.22±1.24 before treatment to −2.61±1.69 during treatment (P=0.008). Alkaline phosphatase decreased during treatmentn (P=0.037). Significant adverse drug reactions and new fractures were not reported.
CONCLUSION
Low-dose pamidronate treatment for quadriplegic children with cerebral palsy increased lumbar BMD and reduced the incidence of fracture.

Keyword

Pamidronate; Osteoporosis; Cerebral palsy; Bone density; Quadriplegia

MeSH Terms

Alkaline Phosphatase
Anticonvulsants
Biomarkers
Bone Density
Calcium
Cerebral Palsy*
Child*
Classification
Drug-Related Side Effects and Adverse Reactions
Female
Humans
Hypoxia, Brain
Incidence
Male
Metabolism
Osteoporosis*
Quadriplegia
Risk Factors
Spine
Vitamin D
Alkaline Phosphatase
Anticonvulsants
Biomarkers
Calcium
Vitamin D