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Bisphosphonate use for osteoporosis in children with ALL

Peter J Simm, Andrew Biggin, Margaret R Zacharin, Christine P Rodda, Elaine Tham, Aris Siafarikas, Craig Jefferies, Paul L Hofman, Diane E Jensen, Helen Woodhead, Justin Brown, Benjamin J Wheeler, Denise Brookes, Antony Lafferty, Craig F Munns
Bisphosphonate therapy is the mainstay of pharmacological intervention in young people with skeletal fragility. The evidence of its use in a variety of conditions remains limited despite over three decades of clinical experience. On behalf of the Australasian Paediatric Endocrine Group, this evidence-based consensus guideline presents recommendations and discusses the graded evidence (using the GRADE system) for these recommendations. Primary bone fragility disorders such as osteogenesis imperfecta are considered separately from osteoporosis secondary to other clinical conditions (such as cerebral palsy, Duchenne muscular dystrophy)...
March 2018: Journal of Paediatrics and Child Health
Jennifer M Bell, Michael D Shields, Janet Watters, Alistair Hamilton, Timothy Beringer, Mark Elliott, Rosaline Quinlivan, Sandya Tirupathi, Bronagh Blackwood
BACKGROUND: Corticosteroid treatment is considered the 'gold standard' for Duchenne muscular dystrophy (DMD); however, it is also known to induce osteoporosis and thus increase the risk of vertebral fragility fractures. Good practice in the care of those with DMD requires prevention of these adverse effects. Treatments to increase bone mineral density include bisphosphonates and vitamin D and calcium supplements, and in adolescents with pubertal delay, testosterone. Bone health management is an important part of lifelong care for patients with DMD...
January 24, 2017: Cochrane Database of Systematic Reviews
Dennis E Carey, Neville H Golden
Osteoporosis occurs during childhood and adolescence as a heritable condition such as OI, with acquired disease (eg, IBD), or iatrogenically as a result of high-dose glucocorticoid therapy. However, the number of children affected by osteoporosis during youth is small compared to the numbers who will develop osteoporosis in adulthood. Prevention of adult osteoporosis requires that an optimal environment for the achievement of peak bone mass be established during the growing years. Detection of low BMD can be achieved using modalities such as DXA and pQCT...
August 2015: Adolescent Medicine: State of the Art Reviews
Amit Bhardwaj, Kye Mon Min Swe, Nirmal K Sinha, Ifeyinwa Osunkwo
BACKGROUND: Osteoporosis is a systemic skeletal disease characterized by low bone mass and micro-architectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture. Osteoporosis represents an important cause of morbidity in people with beta-thalassaemia and its pathogenesis is multifactorial. Factors include bone marrow expansion due to ineffective erythropoiesis, resulting in reduced trabecular bone tissue with cortical thinning; endocrine dysfunction secondary to excessive iron loading, leading to increased bone turnover; and lastly, a predisposition to physical inactivity due to disease complications with a subsequent reduction in optimal bone mineralization...
March 10, 2016: Cochrane Database of Systematic Reviews
Elizabeth A Szalay
Bisphosphonates (BPs) are used most commonly in children with osteogenesis imperfecta, resulting in increased trabeculae and cortical thickness, increased bone density as measured by DXA (Dual Energy X-ray Absorptiometry), and improved vertebral morphology. Less well documented in controlled trials are decrease in long bone fractures, improved strength and motor function, and decreased pain. Outside of children with osteogenesis imperfecta, use of bisphosphonates in children is increasing, all of which is off-label...
2014: Journal of Pediatric Rehabilitation Medicine
Jae Min Lee, Ji Eun Kim, Soon Hwan Bae, Jeong Ok Hah
BACKGROUND: Reduced bone mineral density (BMD) is a significant sequelae in children receiving chemotherapy for acute lymphoblastic leukemia (ALL) and non-Hodgkin lymphoma (NHL). Reduced BMD is associated with an increased risk for fractures. Pamidronate, a second-generation bisphosphonate, has been used to treat osteoporosis in children. This study evaluated the safety and efficacy of pamidronate in children with low BMD during and after chemotherapy for ALL and NHL. METHODS: Between April 2007 and October 2011, 24 children with ALL and NHL were treated with pamidronate...
June 2013: Blood Research
A Marco Puche, I Calvo Penades, B Lopez Montesinos
OBJECTIVE: Calcinosis is a frequent finding in up to 40% of children with juvenile dermatomyositis (JDM). Different treatments (aluminum hydroxide, diltiazem, probenecid, alendronate, etc.) have been used in an attempt to clear calcinosis and to avoid the onset of new calcium deposition, but none has been clearly effective. Pamidronate is a nitrogen-containing bisphosphonate with a potent inhibiting bone resorption effect that has been used to treat osteoporosis in children. We report three children with JDM who developed calcinosis and who received intravenous pamidronate with good results...
January 2010: Clinical and Experimental Rheumatology
Michele L Bryant, Mary A Worthington, Kerry Parsons
OBJECTIVE: To evaluate the efficacy and safety of various treatment options for osteopenia and osteoporosis secondary to cancer treatment in pediatric patients undergoing cancer therapy. DATA SOURCES: A systematic search of PubMed (1949-November 2008) and International Pharmaceutical Abstracts (to November 2008) was conducted using the following search terms: osteoporosis, osteopenia, pediatrics, cancer, neoplasms, chemotherapy, bisphosphonates, calcium, vitamin D, calcitonin, and physical therapy...
April 2009: Annals of Pharmacotherapy
Toshiyuki Iwasaki, Kenji Takei, Shinya Nakamura, Nozomi Hosoda, Yukifumi Yokota, Masahiro Ishii
BACKGROUND: The aim of the present paper was to investigate 20 pediatric patients with cerebral palsy and secondary osteoporosis and consider the efficacy, influence and index of treatment. METHODS: A total of 10 boys and 10 girls, age 1-16 years (mean 7.6 years) with secondary osteoporosis and cerebral palsy treated for 6 months, were studied. Bone mineral density (BMD) was measured. The bone turnover markers were measured just before and 4 months after treatment or at the time of early discontinuation of treatment...
June 2008: Pediatrics International: Official Journal of the Japan Pediatric Society
J J Brown, L Ramalingam, M R Zacharin
BACKGROUND: Bisphosphonate use in adult patients has been linked to osteonecrosis of the jaw (ONJ). This complication has not been systematically assessed in a paediatric population receiving bisphosphonates. OBJECTIVE: To assess our cohort of paediatric patients treated with intravenous bisphosphonate for occurrence of ONJ. DESIGN: Observational study at a tertiary children's hospital. PATIENTS: A total of 42 paediatric patients with osteoporosis who received bisphosphonate infusions for a mean of 6...
June 2008: Clinical Endocrinology
Christopher Lethaby, John Wiernikowski, Alessandra Sala, Marissa Naronha, Colin Webber, Ronald D Barr
BACKGROUND: Osteopenia is a common consequence of the treatment of acute lymphoblastic leukemia (ALL) in children and adolescents, due predominantly to glucocorticosteroid therapy. The pathogenesis relates to an imbalance of resorption over formation of bone. METHODS: Alendronate (Fosamax), an inhibitor of osteoclastic bone resorption, was administered for at least 6 months to 15 children with ALL during maintenance chemotherapy, after the diagnosis of osteopenia/osteoporosis by dual energy x-ray absorptiometry...
September 2007: Journal of Pediatric Hematology/oncology
J Thornton, D M Ashcroft, M Z Mughal, R A Elliott, T W O'Neill, D Symmons
AIMS: To evaluate the currently available evidence for the effectiveness of bisphosphonates in children with low bone mineral density (BMD) and fragility fractures associated with juvenile idiopathic arthritis (JIA), and the safety of bisphosphonates in JIA and other conditions. METHODS: Literature databases were searched using a structured search strategy. The effectiveness review included any studies of children with JIA treated with bisphosphonates. The safety review also included studies of osteogenesis imperfecta...
September 2006: Archives of Disease in Childhood
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