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Clinical Review: Bisphosphonate Use in Childhood Osteoporosis

Stanford University School of Medicine (L.K.B.), Stanford, California 94305; and Pediatric Bone Health Clinical and Research Programs (L.M.W.), Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada K1H 8L1

Address all correspondence and requests for reprints to: Laura K. Bachrach, M.D., Room H314, Stanford Medical Center, 300 Pasteur Drive, Stanford, California 94305-5208. E-mail: lkbach{at}stanford.edu.

Context: As awareness of osteoporosis in childhood has increased, so have pressures to consider use of the pharmacological agents used to treat osteoporosis in adults. This review examines available research on the efficacy and safety of bisphosphonate therapy for pediatric osteoporosis.

Evidence Acquisition: We reviewed the medical literature for key articles and consensus statements on the use of bisphosphonates in children through June 2008.

Evidence Synthesis: We compared reports using varying bisphosphonate agents, doses, and duration of therapy to treat osteogenesis imperfecta and a variety of secondary causes of osteoporosis in children. Conclusions drawn from a recently published Cochrane analysis and the consensus statements from experts in the field were considered as well.

Conclusions: Use of bisphosphonate therapy in pediatric patients remains controversial because of inadequate long-term efficacy and safety data. For this reason, many experts recommend limiting use of these agents to those children with recurrent extremity fractures, symptomatic vertebral collapse, and reduced bone mass. Current data are inadequate to support the use of bisphosphonates in children to treat reductions in bone mass/density alone. More research is needed to define appropriate indications for bisphosphonate therapy and the optimal agent, dose, and duration of use in pediatric patients.