Pamidronate treatment of severe osteogenesis imperfecta in children under 3 years of age.

Abstract

Severe osteogenesis imperfecta (OI) is a hereditary disorder characterized by increased bone fragility and progressive bone deformity. Cyclical pamidronate infusions improve clinical outcome in children older than 3 yr of age with severe OI. Because earlier treatment may have potential to prevent deformities and improve functional prognosis in young children, we studied nine severely affected OI patients under 2 yr of age (2.3-20.7 months at entry) for a period of 12 months. Pamidronate was administered i.v. in cycles of 3 consecutive days. Patients received four to eight cycles during the treatment period, with cumulative doses averaging 12.4 mg/kg. Clinical changes were evaluated regularly during treatment, and radiological changes were assessed after 6-12 months of treatment. The control group consisted of six age-matched, severely affected OI patients, who had not received pamidronate treatment. During treatment bone mineral density (BMD) increased between 86-227%. The deviation from normal, as indicated by the z-score, diminished from -6.5 +/- 2.1 to -3.0 +/- 2.1 (P < 0.001). In the control group the BMD z-score worsened significantly. Vertebral coronal area increased in all treated patients (11.4 +/- 3.4 to 14.9 +/- 1.8 cm2; P < 0.001), but decreased in the untreated group (P < 0.05). In the treated patients, fracture rate was lower than in control patients (2.6 +/- 2.5 vs. 6.3 +/- 1.6 fractures/year; P < 0.01). No adverse side-effects were noted, apart from the well known acute phase reaction during the first infusion cycle. Pamidronate treatment in severely affected OI patients under 3 yr of age is safe, increases BMD, and decreases fracture rate.

• Authors: H Plotkin, F Rauch, N J Bishop, K Montpetit, J Ruck-Gibis, R Travers, F H Glorieux
• Journal: The Journal of clinical endocrinology and metabolism (J Clin Endocrinol Metab) Vol. 85 Issue 5 Pg. 1846-50 (May 2000) ISSN: 0021-972X [Print] United States
• PMID: 10843163 (Publication Type: Clinical Trial, Controlled Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Diphosphonates
• Pamidronate

Topics

• Bone Density (drug effects)
• Diphosphonates (therapeutic use)
• Female
• Fractures, Bone (prevention & control)
• Humans
• Infant
• Lumbar Vertebrae (diagnostic imaging)
• Male
• Osteogenesis Imperfecta (diagnostic imaging, drug therapy, physiopathology)
• Pamidronate
• Radiography