Article

Osteoporosis is a common complication in children with motor impairments. They
have a higher risk of fractures (20% during their lifetime) mostly at femoral
level. Furthermore, these children have pain yet no clear relation has been
established between osteoporosis and pain. The efficacy of bisphosphonates has
been validated in adults and for children with osteogenesis imperfecta (OI).
However, its use in children with motor impairments has not yet been validated.
METHODS: Retrospective study on the medical charts of children
presenting neurological diseases and motor impairments associated to secondary
symptomatic osteoporosis. These children underwent treatment with
Pamidronate((R)) intravenous infusions (I.V.) in Lyon and Valence between 2002
and 2008. Data were collected on pain control, incidence and frequency of
fractures and bone mass density (BMD). Data on adverse events were also collected
to evaluate treatment's tolerance. RESULTS: Twelve children's charts were studied
for a total of 50 Pamidronate((R)) I.V. infusions. Regarding treatment's
efficacy, we observed a clear decrease and even total relief of the pain with
improvement reported after 98% of perfusions. Regarding BMD, there was a real
improvement after the treatment (e.g., lumbar BMD measures, -46.5% before
treatment and -27% after treatment). The adverse events, flu-like syndrome,
muscle pain and asymptomatic hypocalcemia, were minor and quickly reversible.
CONCLUSION: It seems quite essential to screen for osteoporosis-related pain in
these children and treat them quickly to avoid a negative impact on their quality
of life. Treatment with I.V. bisphosphonates has shown its relevance, yet
practical modalities still need to be defined. It would be interesting but quite
difficult to implement, in light of the positive effect of this study, a
prospective, randomized, controlled, double-blind vs. placebo study on a large
enough sample of patients.
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Langue : ANGLAIS