Endocrine Abstracts

Aim: To review trends in bisphosphonate use in children with secondary osteoporosis attending a Tertiary Paediatric Endocrine Unit (2004–July 2015).

Methods: Data were gathered from a combination of a clinical and pharmacy database. Results reported as median (range).

Results: A total of 42 children (19M) commenced on bisphosphonates treatment over the 11-year period, median age 11.8 years (3.3–18.4). 19 were on pamidronate (3–6 monthly), 14 zoledronate (6–12 monthly), and one risedronate. I.v. zoledronate was introduced after 2011. Fracture and DXA data at start of therapy was available for 34 children. Fractures prior to treatment were: 12/34 (35.3%) vertebral fracture, 7/34 (20.6%) recurrent appendicular fractures (11 femoral, two tibial, four tibia/fibula, and four humeral), 11/34 (32.4%) single appendicular fracture (one radius/ulna, five femoral, two tibial, one radial, one navicular, and one phalangeal) in four children with immobility (two cerebral palsy, one maple urine syrup disease, and one spinal cord injury), two leukaemia, one duchenne muscular dystrophy, one juvenile arthritis, and one severe asthma on long-term oral glucocorticoid. DXA was assessed in 24/34 (70.6%) prior to commencement of bisphosphonates and was repeated during treatment in 12/24 (50%). Of those with no DXA prior to treatment, 8/12 were due children with immobility and/or significant learning difficulties.

Of the 12 patients with vertebral fractures, all were multiple. All were treated for painful compression fractures. 4/14 (28.6%) of those with vertebral fractures had repeat spine X-rays during treatment. None of them showed vertebral reconstitution but no new fractures were identified.

Conclusion: The number of children with secondary osteoporosis commenced on bisphosphonates therapy is increasing over the period of audit. This could reflect increasing detection of fractures in children with chronic disease, referral from other sub-specialties and increasing confidence in the use of bisphosphonates. Investigation and monitoring of patients is inconsistent, although the appropriate method to determine response following bisphosphonates therapy is unclear.