Decreased fracture incidence after 1 year of pamidronate treatment in children with spastic quadriplegic cerebral palsy.
OBJECTIVE
The aim of this study was to assess the rate of fracture before and after a 1-year course of intravenous pamidronate in children with spastic quadriplegic cerebral palsy (CP) who had previously experienced fractures.


METHODS
Twenty-five children (nine males, 16 females) with quadriplegic CP in Gross Motor Function Classification System (GMFCS) level IV or V who were treated with intravenous pamidronate for approximately 1 year were identified. All participants had previously experienced at least one non-traumatic fracture. Each received 15 doses of pamidronate over a mean of 13.6 months. Post-treatment observation ranged from 1 to 10 years 6 months (mean 4 y 1 mo). The fracture rate before and after commencement of treatment was calculated using the person-years method.


RESULTS
The participants had experienced a total of 86 fractures before treatment began, occurring over 280.6 person-years, giving a fracture rate of 30.6% per year. During the post-treatment observation period, totalling 107.5 person-years, 8 of the 25 children experienced a total of 14 fractures. This fracture rate of 13.0% per year is a statistically significant decrease (p=0.02).


CONCLUSIONS
Pamidronate treatment lowered the rate of fracture, and a 1-year course appears to provide a protective effect after treatment ends. For the majority of participants, this effect lasted 4 years or longer. However, a subset of children suffered a fracture soon after the drug was discontinued. In these children, a longer course of treatment appears to have been necessary.
Bachrach
Steven J
SJ
Department of Pediatrics, Alfred I duPont Hospital for Children, Nemours Children's Clinic, Wilmington, DE, USA. sbachrac@nemours.org
Kecskemethy
Heidi H
HH
Harcke
H Theodore
HT
Hossain
Jobayer
J
D000293:Adolescent; D000367:Age Factors; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D004164:Diphosphonates / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D000077268:Pamidronate; D011782:Quadriplegia / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D000077268:Pamidronate