Low doses of pamidronate to treat osteopenia in children with severe cerebral palsy: a pilot study
2007; Wiley; Volume: 48; Issue: 9 Linguagem: Inglês
10.1111/j.1469-8749.2006.tb01353.x
ISSN1469-8749
AutoresHoracio Plotkin, Susan Coughlin, Rose Kreikemeier, Kathryn Heldt, Matías Bruzoni, Gary Lerner,
Tópico(s)Botulinum Toxin and Related Neurological Disorders
ResumoDevelopmental Medicine & Child NeurologyVolume 48, Issue 9 p. 709-712 Free Access Low doses of pamidronate to treat osteopenia in children with severe cerebral palsy: a pilot study Horacio Plotkin MD FAAP, Corresponding Author Horacio Plotkin MD FAAP Inherited Metabolic Diseases Section, Department of Pediatrics, University of Nebraska Medical Center*Correspondence to first author at 985456 Nebraska Medical Center, Omaha, NE 68198–5456, USA. E-mail: hplotkin@unmc.eduSearch for more papers by this authorSusan Coughlin RN, Susan Coughlin RN Children's Hospital OmahaSearch for more papers by this authorRose Kreikemeier MSN CPNP, Rose Kreikemeier MSN CPNP Children's Hospital OmahaSearch for more papers by this authorKathryn Heldt RD LMNT CDE, Kathryn Heldt RD LMNT CDE Children's Hospital OmahaSearch for more papers by this authorMatias Bruzoni MD, Matias Bruzoni MD Inherited Metabolic Diseases Section, Department of Pediatrics, University of Nebraska Medical Center, OmahaSearch for more papers by this authorGary Lerner MD, Gary Lerner MD Children's Hospital Omaha, Nebraska, USA.Search for more papers by this author Horacio Plotkin MD FAAP, Corresponding Author Horacio Plotkin MD FAAP Inherited Metabolic Diseases Section, Department of Pediatrics, University of Nebraska Medical Center*Correspondence to first author at 985456 Nebraska Medical Center, Omaha, NE 68198–5456, USA. E-mail: hplotkin@unmc.eduSearch for more papers by this authorSusan Coughlin RN, Susan Coughlin RN Children's Hospital OmahaSearch for more papers by this authorRose Kreikemeier MSN CPNP, Rose Kreikemeier MSN CPNP Children's Hospital OmahaSearch for more papers by this authorKathryn Heldt RD LMNT CDE, Kathryn Heldt RD LMNT CDE Children's Hospital OmahaSearch for more papers by this authorMatias Bruzoni MD, Matias Bruzoni MD Inherited Metabolic Diseases Section, Department of Pediatrics, University of Nebraska Medical Center, OmahaSearch for more papers by this authorGary Lerner MD, Gary Lerner MD Children's Hospital Omaha, Nebraska, USA.Search for more papers by this author First published: 13 February 2007 https://doi.org/10.1111/j.1469-8749.2006.tb01353.xCitations: 7AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract The aim of this study was to test the efficacy of low doses of pamidronate in increasing bone mineral density (BMD) in non-ambulatory children and adolescents with cerebral palsy (CP). Twenty-three non-ambulatory children and adolescents (12 females, 11 males; mean age 10y [SD 5y], range 4y 1mo- 17y 11mo) with severe spastic quadriplegic CP and low BMD were recruited from a multidisciplinary clinic. Severity of CP was graded at Level IV (n=10) and Level V (n=13) using the Gross Motor Function Classification System. Patients received intravenous pamidronate (4.12mg/kg/y, maximum 45mg/d) every 4 months. Lumbar spine and femoral neck BMD were measured at baseline and after 4 and 12 months. Twelve months after the first dose of pamidronate there was a significant increase in lumbar spine and femoral neck BMD (p <0.01 for both sites) and z scores compared with baseline values (p <0.01 for both sites). Mean BMD z scores increased 1.6 points for femoral neck and 1.9 points for lumbar spine after 12 months of pamidronate treatment. Serum intact parathyroid hormone increased significantly and cross-linked N-teleopeptide of type I collagen decreased significantly at 12 months. No significant side effect was noted. Low doses of pamidronate are well tolerated and significantly increase BMD in non-ambulatory children and adolescents with CP. Abbreviations used: BMD Bone mineral density CBC Complete blood count iPTH Intact parathyroid hormone NTx Cross-linked N-teleopeptide of type I collagen References 1 Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N, Dan B, Jacobsson B, Damiano D. (2005) Proposed definition and classification of cerebral palsy, April 2005. Dev Med Child Neurol 47: 571– 576. 2 Rosen MG, Dickinson JC. (1992) The incidence of cerebral palsy. Am J Obstet Gynecol 167: 417– 423. 3 Newacheck P, Taylor WR. (1992) Childhood chronic illness: prevalence, severity, and impact. Am J Public Health 82: 364– 371. 4 Surveillance of Cerebral Palsy in Europe. (2000) Surveillance of Cerebral Palsy in Europe: a collaboration of cerebral palsy surveys and registers. Dev Med Child Neurol 42: 816– 824. 5 King W, Levin R, Schmidt R, Oestreich A, Heubi JE. (2003) Prevalence of reduced bone mass in children and adults with spastic quadriplegia. Dev Med Child Neurol 45: 12– 16. 6 Crichton JU, Mackinnon M, White C P. (1995) The life-expectancy of persons with cerebral palsy. Dev Med Child Neurol 37: 567– 576. 7 Henderson RC, Lin P P, Greene WB. (1995) Bone-mineral density in children and adolescents who have spastic cerebral palsy. J Bone Joint Surg Am 77: 1671– 1681. 8 Sholas MG, Tann B, Gaebler-Spira D. (2005) Oral bisphosphonates to treat disuse osteopenia in children with disabilities: a case series. J Pediatr Orthop 25: 326– 331. 9 Henderson RC, Lark RK, Kecskemethy H, Miller F, Harcke T, Bachrach S. (2002) Bisphosphonates to treat osteopenia in children with quadriplegic cerebral palsy: a randomized, placebo-controlled clinical trial. J Pediat 141: 644– 651. 10 Rauch F, Travers R, Plotkin H, Glorieux FH. (2002) The effects of intravenous pamidronate on the bone tissue of children and adolescents with osteogenesis imperfecta. J Clin Invest 110: 1293– 1299. 11 Whyte M P, Wenkert D, Clements KL, McAlister WH, Mumm S. (2003) Bisphosphonate-induced osteopetrosis. N Eng J Med 349: 457– 463. 12 Gandrud LM, Cheung JC, Daniels M W, Bachrach LK. (2003) Low-dose intravenous pamidronate reduces fractures in childhood osteoporosis. J Pediatr Endocrinol Metab 16: 887– 892. 13 Gonzalez E, Pavia C, Ros J, Villaronga M, Valls C, Escola J. (2001) Efficacy of low dose schedule pamidronate infusion in children with osteogenesis imperfecta. J Pediatr Endocrinol Metab 14: 529– 533. 14 Steelman J, Zeitler P. (2003) Treatment of symptomatic pediatric osteoporosis with cyclic single-day intravenous pamidronate infusions. J Pediatr 142: 417– 423. 15 Glorieux FH, Bishop NJ, Plotkin H, Chabot G, Lanoue G, Travers R. (1998) Cyclic administration of pamidronate in children with severe osteogenesis imperfecta. N Eng J Med 339: 947– 952. 16 Plotkin H, Rauch F, Bishop N, Montpetit K, Ruck-Gibbis J, Travers R, Glorieux F. (2000) Pamidronate treatment of severe osteogenesis imperfecta in children under three years of age. J Clin Endoc Metab 85: 1846– 1850. 17 Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. (1997) Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol 39: 214– 223. 18 Henderson RC, Kairalla JA, Barrington J W, Abbas A, Stevenson RD. (2005) Longitudinal changes in bone density in children and adolescents with moderate to severe cerebral palsy. J Pediatr 146: 769– 775. 19 Hahn TJ, Hendin BA, Scharp CR, Boisseau VC, Haddad JGJ. (1975) Serum 25-hydroxycalciferol levels and bone mass in children on chronic anticonvulsant therapy. N Eng J Med 292: 550– 554. 20 Plotkin H, Rauch F, Zeitlin L, Munns C, Travers R, Glorieux FH. (2003) Effect of pamidronate treatment in children with polyostotic fibrous dysplasia of bone. J Clin Endocrinal Metab 88: 4569– 4575. 21 Rauch F, Plotkin H, Travers R, Zeitlin L, Glorieux FH. (2003) Osteogenesis imperfecta types I, III and IV: effect of pamidronate therapy on bone and mineral metabolism. J Clin Endoc Metab 88: 986– 992. 22 Rosen CJ. (2003) Severe hypocalcaemia after intravenous bisphosphonate therapy in occult vitamin D deficiency. N Engl J Med 348: 1503– 1504. 23 Peter R, Mishra V, Fraser WD. (2004) Severe hypocalcaemia after being given intravenous bisphosphonate. BMJ 328: 335– 336. Citing Literature Volume48, Issue9September 2006Pages 709-712 ReferencesRelatedInformation
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