Bone health

Guidelines advise on use of bisphosphonates in kids

 Guidelines on the use of bisphosphonates in children and adolescents have been published by the APEG Bone Mineral Working Group.

Published in the Journal of Paediatrics and Child Health, the expert group led by Dr Peter Simm from the Murdoch Children’s Research Institute say pharmacological treatment of paediatric osteoporosis has largely been confined to the use of bisphosphonate drugs for over three decades, yet their use in this patient population is still controversial.

Key recommendations in the guidelines include:

  • Intravenous bisphosphonates should be considered for use in children with severe osteogenesis imperfecta (OI) (e.g. type III), children with vertebral compression fractures or children who have had two or more long-bone fractures per year.
  • Oral bisphosphonates should only be considered for those with mild to moderate OI in the absence of vertebral compression fractures.
  • Children with severe OI should not cease therapy once BMD improves; but should continue on a long-term lower dose of bisphosphonate to preserve bone strength during growth.
  • Bisphosphonates should be considered in children with severe forms of idiopathic juvenile osteoporosis
  • In secondary osteoporosis children with vertebral fractures and/or low BMD and two or more long bone fragility fractures should be considered for intravenous bisphosphonate therapy.
  • To minimise the risk of hypocalcaemia serum vitamin D levels should be >50 nmol/L prior to the first infusion and adequate calcium intake should be maintained post-infusion.
  • Regular clinical monitoring for children and young adolescents on bisphosphonate therapy should include annual BMD assessment where feasible and vitamin D assessment and general biochemistry.

Access the full set of guidelines here.

The guideline authors conclude that bisphosphonates are the main therapeutic agent for young people with significant skeletal fragility and are also useful in a small but important number of other clinical settings.

“Use of these agents should be undertaken in centres with sufficient expertise and ongoing monitoring by a physician experienced in their effects,” the working group authors added.

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