Bisphosphonates may make children’s bone brittle
Bisphosphonates should be used with caution in children, says Dr Joan Marini, of the United States National Institute of Child Health, Bethesda, Maryland.
Her warning follows a report of drug-induced osteopetrosis (a disorder
characterised by increased bone density) in a 12-year-old boy. He had
been treated with disodium pamidronate for over two and a half years
to relieve bone pain and increase bone mass (New England Journal of Medicine
2003;349:457).
Initially a dose of 10mg (0.37mg per kilogram body weight) infused intravenously
on three consecutive days was used but the dose was increased to 60mg
every three weeks. The dose was increased again to 100mg, although this
was reportedly administered less frequently.
Dr Marini comments that although published data on bisphosphonates is
almost uniformly positive, anecdotal reports suggest that in children,
prolonged administration increases the risk that bone will become brittle
rather than better.
She suggests that lower doses of bisphosphonates, used at longer intervals,
may provide benefit without a long-term reduction in bone quality. “Alternating
treatment periods with extended drug holidays could lead to a more normal
bone quality than does continuous treatment,” she adds (ibid, p423).
Bisphosphonates are not licensed for use in children in the United Kingdom. |
