Prevention of postoperative osteopenia using IV pamidronate: a pilot study.

Abstract

BACKGROUND:

Postoperative bone mineral density (BMD) loss, especially after cast immobilization and/or non-weight-bearing, is a well-known phenomenon in children that can cause fracture. Children with marginal bone density are at greatest risk. This prospective randomized control trial compared the effect of single-dose intravenous (IV) pamidronate versus placebo to prevent postoperative BMD loss.

METHODS:

Children between the ages of 4 and 18 were included in the study; inclusion criteria included a predisposition to low bone density and hip or lower extremity surgery that would require cast immobilization or non-weight-bearing for at least 4 weeks. Dual-energy x-ray absorptiometry (DXA) scans of the lumbar spine and bilateral distal femora were performed preoperatively and at least 4 weeks postoperatively. Subjects were randomized to receive either a single, low dose of IV pamidronate (1 mg/kg) or placebo, given during the immediate postoperative period. Changes in the BMD were compared using the Mann-Whitney test for significance in the lumbar spine. A multivariate general linear model was used to compare the effect of surgery, DXA region, and treatment on BMD.

RESULTS:

A total of 24 subjects were included in the study, and 20 completed the protocol. Pamidronate-treated subjects showed a statistically significant difference with a median gain in BMD of 0.029 gm/cm in the lumbar spine compared with the control group, which showed a median loss of 0.025 gm/cm. Treatment did not have a statistically significant effect on BMD loss in the distal femur but trended toward decreased BMD loss (treatment=0.0331 gm/cm, control=0.0416 gm/cm). There were no complications or adverse reactions.

CONCLUSIONS:

This small pilot study shows that single-dose postoperative pamidronate mitigated postoperative BMD loss in at-risk children, which may in turn decrease postoperative fracture risk. Further investigation into the use of IV pamidronate in postoperative patients is warranted.

LEVEL OF EVIDENCE:

Level 1 double-blinded randomized control trial.

• Authors: Bryon D Hobby, Samuel Dominguez-Bartmess, Elizabeth A Szalay
• Journal: Journal of pediatric orthopedics (J Pediatr Orthop) 2013 Oct-Nov Vol. 33 Issue 7 Pg. 763-7 ISSN: 1539-2570 [Electronic] United States
• PMID: 23872799 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Bone Density Conservation Agents
• Diphosphonates
• Pamidronate

Topics

• Absorptiometry, Photon
• Administration, Intravenous
• Adolescent
• Bone Density
• Bone Density Conservation Agents (administration & dosage, therapeutic use)
• Bone Diseases, Metabolic (etiology, prevention & control)
• Child
• Child, Preschool
• Diphosphonates (administration & dosage, therapeutic use)
• Female
• Humans
• Linear Models
• Male
• Multivariate Analysis
• Pamidronate
• Pilot Projects
• Postoperative Complications (prevention & control)
• Prospective Studies
• Statistics, Nonparametric
• Treatment Outcome