title: Use of zoledronic acid for treatment of chemotherapy related osteonecrosis in children and adolescents: a retrospective analysis.
abstract: BACKGROUND
  Osteonecrosis (ON) is a disabling complication of chemotherapy, especially steroids in children and adolescents. There are few reports in the literature of non-surgical management of ON. Patients with chemotherapy related ON, treated with zoledronic acid (ZA) were analyzed for clinical and radiological outcome.
  
  
  METHODS
  Retrospective chart review. Serial joint radiographs were performed to assess response and graded according to Association Research Circulation Osseous (ARCO) system. All patients were evaluated for bone turnover and bone mineral density (BMD) at set intervals.
  
  
  RESULTS
  Twenty children with ON were treated with ZA for median duration of 13 months (range 5-25) with median number of doses being 6 (2, 8). Five (25%) patients were pain free at the end of treatment and had minimal joint destruction on X-ray (ARCO score II); 5 (25%) underwent arthroplasty due to severe joint destruction and pain limiting activity (ARCO score III/IV); 10 (50%) reported ongoing pain with activity, none on regular analgesia. BMD analysis showed increase in lumbosacral BMD after 1 year of treatment. Compared to patients with ON of the knees, majority of patients with ON of the hips had radiological progression.
  
  
  CONCLUSIONS
  ZA was well tolerated and improved joint pain in the majority of patients. Despite treatment with ZA, most patients with ON of hips had progressive joint destruction requiring arthroplasty. Patients with ON of the knees appeared to have radiological stabilization. Novel treatment strategies should be considered to prevent this debilitating complication in survivors of childhood cancer.
authors.affiliation: Department of Oncology, The Children's Hospital at Westmead, Sydney, Australia. bhavna.padhye@health.nsw.gov.au
authors.forename: Bhavna
authors.initials: B
authors.lastname: Padhye
authors.forename: Luciano
authors.initials: L
authors.lastname: Dalla-Pozza
authors.forename: David G
authors.initials: DG
authors.lastname: Little
authors.forename: Craig F
authors.initials: CF
authors.lastname: Munns
mesh_terms: D000293:Adolescent; D018771:Arthralgia / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy; D001178:Arthroplasty; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D004164:Diphosphonates / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage* / Q000009:adverse effects; D008223:Lymphoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D010020:Osteonecrosis / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D011859:Radiography; D012189:Retrospective Studies; D013997:Time Factors; D000077211:Zoledronic Acid
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D000077211:Zoledronic Acid
keywords: chemotherapy; osteonecrosis; pediatric; zoledronic acid