title: Low doses of pamidronate to treat osteopenia in children with severe cerebral palsy: a pilot study.
abstract: The aim of this study was to test the efficacy of low doses of pamidronate in increasing bone mineral density (BMD) in non-ambulatory children and adolescents with cerebral palsy (CP). Twenty-three non-ambulatory children and adolescents (12 females, 11 males; mean age 10y [SD 5y], range 4y 1 mo-17 y 11 mo) with severe spastic quadriplegic CP and low BMD were recruited from a multidisciplinary clinic. Severity of CP was graded at Level IV (n=10) and Level V (n=13) using the Gross Motor Function Classification System. Patients received intravenous pamidronate (4.12 mg/kg/y, maximum 45 mg/d) every 4 months. Lumbar spine and femoral neck BMD were measured at baseline and after 4 and 12 months. Twelve months after the first dose of pamidronate there was a significant increase in lumbar spine and femoral neck BMD (p<0.01 for both sites) and z scores compared with baseline values (p<0.01 for both sites). Mean BMD z scores increased 1.6 points for femoral neck and 1.9 points for lumbar spine after 12 months of pamidronate treatment. Serum intact parathyroid hormone increased significantly and cross-linked N-teleopeptide of type I collagen decreased significantly at 12 months. No significant side effect was noted. Low doses of pamidronate are well tolerated and significantly increase BMD in non-ambulatory children and adolescents with CP.
authors.affiliation: Inherited Metabolic Diseases Section, Department of Pediatrics, University of Nebraska Medical Center, NE 68198-5456, USA. hplotkin@unmc.edu
authors.forename: Horacio
authors.initials: H
authors.lastname: Plotkin
authors.forename: Susan
authors.initials: S
authors.lastname: Coughlin
authors.forename: Rose
authors.initials: R
authors.lastname: Kreikemeier
authors.forename: Kathryn
authors.initials: K
authors.lastname: Heldt
authors.forename: Matias
authors.initials: M
authors.lastname: Bruzoni
authors.forename: Gary
authors.initials: G
authors.lastname: Lerner
mesh_terms: D000293:Adolescent; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D001851:Bone Diseases, Metabolic / Q000188:drug therapy* / Q000209:etiology*; D002547:Cerebral Palsy / Q000150:complications* / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D004164:Diphosphonates / Q000008:administration & dosage*; D019988:Children with Disabilities; D004305:Dose-Response Relationship, Drug; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D051346:Mobility Limitation; D000077268:Pamidronate; D010865:Pilot Projects; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000077268:Pamidronate