Two-year clinical trial of oral alendronate versus intravenous pamidronate in children with osteogenesis imperfecta.
A 2-year prospective, partially randomized open-label trial comparing oral alendronate with intravenous pamidronate therapy in children with OI showed equivalence in increasing total body BMD, spine BMD, and linear growth, and decreasing bone turnover and fracture incidence. Children with mild OI had greater responses than severe OI in BMD and growth.


BACKGROUND
Bisphosphonate therapies increase BMD and may reduce fractures in children with osteogenesis imperfecta (OI). A study directly comparing oral with intravenous bisphosphonate has not been published. This clinical trial compares oral alendronate with intravenous pamidronate in children with OI using an open-label, prospective, 2-year, randomized design.


METHODS
Children over the age of 3 years were stratified by bone age, pubertal stage, and type of OI and then randomized to receive oral alendronate 1 mg/kg/day in tablet form or intravenous pamidronate, 3 mg/kg/4 months. One child was assigned to pamidronate. One child randomized to intravenous pamidronate changed to oral alendronate. Eighteen children completed 12 months of therapy: nine on oral alendronate and nine on intravenous pamidronate. Primary outcome efficacy was increase in BMD. Secondary outcomes included changes in bone turnover biomarkers, fracture incidence, and growth.


RESULTS
Total body and lumbar spine BMD increased, turnover markers decreased, and linear growth increased equivalently with oral and intravenous therapy. Fracture incidence showed a trend to decrease in both groups, with a significant decrease in fracture rates when the oral and intravenous groups were pooled. There were greater responses in BMD and growth in children with milder OI (type I) than those with more severe disease (types III and IV), but there were no significant effects of age or pubertal stage.


CONCLUSIONS
Oral and intravenous bisphosphonate therapies are equally effective in children with OI and are particularly effective in milder forms. The oral route is highly acceptable in children and has practical advantages over the intravenous route.
DiMeglio
Linda A
LA
Department of Pediatrics, Section of Pediatric Endocrinology and Diabetology, Indiana University School of Medicine, Indianapolis, Indiana, USA. dimeglio@iupui.edu
Peacock
Munro
M
D000284:Administration, Oral; D019386:Alendronate / Q000008:administration & dosage*; D015415:Biomarkers / Q000378:metabolism; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D016723:Bone Remodeling / Q000187:drug effects*; D002648:Child; D004164:Diphosphonates / Q000008:administration & dosage*; D005260:Female; D050723:Fractures, Bone / Q000378:metabolism / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous; D008297:Male; D010013:Osteogenesis Imperfecta / Q000188:drug therapy* / Q000378:metabolism; D000077268:Pamidronate; D011446:Prospective Studies
D015415:Biomarkers; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000077268:Pamidronate; D019386:Alendronate