Adverse Events Due to IV Bisphosphonates for Paediatric Osteoporosis Are Usually Mild, Manageable

By Louise Gagnon

TORONTO — May 10, 2018 — Bisphosphonates are safe to administer intravenously to children who have developed secondary osteoporosis, according to a study presented here at the 2018 Annual Meeting of the Pediatric Academic Societies (PAS).

“We wanted to get better sense of the impact of IV bisphosphonates on both primary and secondary osteoporosis,” said Nat Nasomyont, MD, Cincinnati Children’s HospitalMedical Center, Cincinnati, Ohio. “The data on secondary osteoporosis is quite limited.”

The researchers looked at data from patients aged younger than 21 years who received IV pamidronate (n = 779) or IV zoledronic acid (n = 163) between 2010 and 2017.

“As we expected, we saw children with primary osteoporosis were started on treatment at a young age,” said Dr. Nasomyont.

Acute adverse events occurred in 5.5% of infusions and were more frequent in secondary osteoporosis (12.5%; P< .0001) and following the first infusion (29.8%; P = .03).

Another toxicity observed was hypocalcaemia, which developed in 7.1% of infusions and was linked significantly with the use of zoledronic acid (P = .04). Hypocalcaemia that did develop was mild fr the most part and when needed, managed with intravenous calcium.

“We found that patients who received zoledronic acid are at higher risk of hypocalcaemia,” said Dr. Nasomyont.

He said that patients will often prefer zoledronic acid because it requires fewer infusions than pamidronate as well as shorter duration of infusions.

The researchers found improved measures in trabecular bone mineral density but did not find improvements in cortical bone density.

There were no cases of osteonecrosis of the jaw or atypical femoral fracture.

The data suggest a need for greater vigilance of toxicities in paediatric patients with secondary osteoporosis being treated with IV bisphosphonates. However, “intravenous bisphosphonates can be safely used in paediatric patients with osteoporosis,” the authors concluded.

[Presentation title: Outcome Following Intravenous Bisphosphonate Infusion in Pediatric Patients: a 7-Year Retrospective Chart Review. Abstract 1446.402]



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