Intravenous pamidronate in combination with calcium and vitamin D: highly effective in the treatment of low bone mineral density in inflammatory bowel disease.
OBJECTIVE
Decreased bone mineral density (BMD) is common in inflammatory bowel disease (IBD) and an increased risk of fractures has been reported. Guidelines state bisphosphonate treatment for IBD patients with decreased BMD, but orally available bisphosphonates have been associated with gastrointestinal side effects and the absorption is poor. We investigated whether intravenous pamidronate is a safe and effective treatment.


METHODS
Forty-nine IBD patients with decreased BMD as assessed by DEXA scan were treated with calcium 1000 mg and vitamin D 400 IU daily. In addition, 30 mg of pamidronate was administered intravenously every 3 months. DEXA scanning was performed prior to treatment, after 6 months and after 1 year.


RESULTS
Of 49 IBD patients, 40 were osteoporotic and 9 were osteopenic. Twenty-six patients were female (mean age 40.8) and 23 were male (mean age 43.3). Treatment was discontinued in one patient because of fever after infusion. Otherwise, tolerability was excellent, and no adverse events were documented. A mean 0.51 increase of lumbar spine (L1-L4) T-scores was observed (CI 95% 0.35-0.67; p<0.0004). The effect of treatment on left femoral neck T-scores was less pronounced: 0.39 (CI 95% 0.24-0.53; p<0.0004).


CONCLUSIONS
We conclude that intravenous pamidronate in combination with calcium and vitamin D is a well tolerated strategy for treating Crohn's disease associated osteopenia and osteoporosis. Although uncontrolled, treatment results in a significant increase of BMD in the lumbar spine.
Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands. p.stokkers@amc.uva.nl
Pieter C F
PC
Stokkers
Maartje
M
Deley
Mirjam
M
Van Der Spek
Hein J
HJ
Verberne
Sander J H
SJ
Van Deventer
Daniel W
DW
Hommes
D015502:Absorptiometry, Photon; D000328:Adult; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002118:Calcium / Q000008:administration & dosage* / Q000627:therapeutic use; D004164:Diphosphonates / Q000008:administration & dosage* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000150:complications*; D007262:Infusions, Intravenous; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D000077268:Pamidronate; D016896:Treatment Outcome; D014807:Vitamin D / Q000008:administration & dosage* / Q000627:therapeutic use
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D014807:Vitamin D; D000077268:Pamidronate; D002118:Calcium