title: Oral bisphosphonates to treat disuse osteopenia in children with disabilities: a case series.
abstract: Children with congenital conditions who are nonambulatory have been observed to have pathologic fractures due to disuse osteopenia. Data support the use of intravenous bisphosphonates to treat this in children with disabilities, but there are no data to guide the use of oral bisphosphonate medication. Ten nonambulatory children with disuse osteopenia secondary to either static brain injury or spina bifida were started on alendronate. Investigators completed a chart review of each subject. There were 17 fractures before starting alendronate and 1 fracture in the follow-up period. All children with nociceptive behavior or pain complaints (5/10) had their symptoms resolve after treatment. Despite the presence of gastrointestinal comorbidities (7/10 with a history of gastroesophageal reflux disease, 5/10 taking reflux medication, and 4/10 with PEG tubes), only 1 of the 10 children discontinued the medication secondary to gastrointestinal complaints. This case series offers evidence that disabled nonambulatory children tolerate alendronate, and it may decrease fractures in those at risk from severe disuse osteopenia.
authors.affiliation: Pediatric Rehabilitation Program, Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago, Northwestern University's Feinberg School of Medicine, 345 East Superior Street, Chicago, IL 60611, USA.
authors.forename: Maurice G
authors.initials: MG
authors.lastname: Sholas
authors.forename: Beverly
authors.initials: B
authors.lastname: Tann
authors.forename: Deborah
authors.initials: D
authors.lastname: Gaebler-Spira
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D019386:Alendronate / Q000008:administration & dosage*; D001851:Bone Diseases, Metabolic / Q000188:drug therapy* / Q000209:etiology; D002493:Central Nervous System Diseases / Q000150:complications; D002648:Child; D004164:Diphosphonates / Q000008:administration & dosage; D019988:Children with Disabilities; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology / Q000517:prevention & control*; D005767:Gastrointestinal Diseases / Q000139:chemically induced; D006801:Humans; D007103:Immobilization / Q000009:adverse effects; D008297:Male; D012189:Retrospective Studies
chemical_list: D004164:Diphosphonates; D019386:Alendronate