Effective parenteral clodronate treatment of a child with severe juvenile idiopathic osteoporosis.
We report on an 8 years and 3 months old boy with severe idiopathic juvenile osteoporosis (IJO). Clinical features included multiple fractures, especially of the vertebrae, and neurological symptoms. Biological studies showed non-parathyroid hormone-mediated excessive bone resorption and massive urinary calcium loss. Although IJO is usually a self-limiting condition after puberty, the severity of our patient's manifestations required therapeutic intervention. Clodronate (dichloromethylene-bisphosphonate) was administered parenterally every 3 months for a period of 2 years. Dramatic clinical and biochemical improvement was noted within 2 weeks. All parameters of bone resorption normalised and no new fractures occurred. After 6 months of treatment, radiological improvement with healing of fractures and rebuilding of the vertebral plates was documented. Bone mineral density increased to normal within 1 year and growth velocity was accelerated. After 2 years, treatment was stopped at the age of 10 years and 3 months. One year later, back pain and increasing pain in the knee region recurred. A tibial fracture was evident and, again, bone mineral density was far below normal. Bisphosphonate medication was reinstituted leading to rapid improvement. No side-effects were observed.


CONCLUSIONS
Parenteral clodronate therapy is effective in managing severe idiopathic juvenile osteoporosis.
Melchior
Ralph
R
Children's Hospital, Klinikum Kassel, Kassel, Germany. ralphmelchior@aol.com
Zabel
Bernard
B
Spranger
Jürgen
J
Schumacher
Roland
R
D000367:Age Factors; D000963:Antimetabolites / Q000008:administration & dosage* / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects; D002648:Child; D004002:Clodronic Acid / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007263:Infusions, Parenteral; D008297:Male; D010024:Osteoporosis / Q000188:drug therapy*; D011627:Puberty; D012008:Recurrence
D000963:Antimetabolites; D004002:Clodronic Acid