Delayed osteotomy but not fracture healing in pediatric osteogenesis imperfecta patients receiving pamidronate.
This study evaluated factors influencing fracture (n = 197) and osteotomy (n = 200) healing in children with moderate to severe OI. Pamidronate treatment was associated with delayed healing after osteotomy, but not after fracture. The data suggest that both pamidronate and mechanical factors influence bone healing in this cohort.


BACKGROUND
Intravenous pamidronate is widely used to treat children with moderate to severe osteogenesis imperfecta (OI). However, the effect of this treatment on bone healing is not well characterized. We therefore retrospectively analyzed the healing of lower limb fractures and osteotomies in children with moderate to severe OI, both before and after the start of pamidronate treatment.


METHODS
Bone healing was evaluated on standard radiographs after 197 lower limb fractures (132 femur and 65 tibia) in 82 patients (age at fracture, 0.0-19.9 years) and 200 intramedullary rodding procedures in 79 patients (age at surgery, 1.2-19.8 years). Delayed healing was diagnosed when a fracture or osteotomy line was at least partially visible 12 months after the event.


RESULTS
Delayed fracture healing was observed more frequently during than before pamidronate treatment. However, the effect of pamidronate was no longer significant when age differences were taken into account (odds ratio [OR], 1.76; 95% CI, 0.61-5.10). Better mobility status was a strong independent predictor of delayed healing after fractures that occurred during pamidronate treatment. After osteotomies, delayed healing was more frequent when pamidronate had been started before surgery (OR, 7.29; 95% CI, 2.62-20.3), and this effect persisted after adjustment for multiple confounders. During pamidronate treatment, older age (OR per year of age, 1.25; 95% CI, 1.06-1.47) and osteotomy of the tibia (OR, 3.51; 95% CI, 1.57-7.82) were independent predictors of delayed healing.


CONCLUSIONS
This study suggests that pamidronate therapy is associated with delayed healing of osteotomy sites after intramedullary rodding procedures. Better mobility status, but not pamidronate treatment, seems to be predictive of delayed healing after fractures.
Munns
Craig Fj
CF
Genetics Unit, Shriners Hospital for Children, McGill University, Montréal, Québec, Canada.
Rauch
Frank
F
Zeitlin
Leonid
L
Fassier
François
F
Glorieux
Francis H
FH
D015502:Absorptiometry, Photon; D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D015519:Bone Density; D016723:Bone Remodeling; D001862:Bone Resorption; D001842:Bone and Bones / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D017102:Fracture Healing; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010013:Osteogenesis Imperfecta / Q000000981:diagnostic imaging / Q000188:drug therapy*; D010027:Osteotomy; D000077268:Pamidronate; D013977:Tibia / Q000000981:diagnostic imaging; D013978:Tibial Fractures; D014945:Wound Healing
D000893:Anti-Inflammatory Agents; D004164:Diphosphonates; D000077268:Pamidronate