Clinical review 1: Bisphosphonate use in childhood osteoporosis

J Clin Endocrinol Metab. 2009 Feb;94(2):400-9. doi: 10.1210/jc.2008-1531. Epub 2008 Nov 25.


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.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adolescent
  • Adolescent Development / drug effects
  • Adolescent Development / physiology
  • Biomedical Research / trends
  • Bone Density Conservation Agents / administration & dosage
  • Bone Density Conservation Agents / adverse effects
  • Bone Density Conservation Agents / therapeutic use
  • Child
  • Child Development / drug effects
  • Child Development / physiology
  • Diphosphonates / administration & dosage
  • Diphosphonates / adverse effects
  • Diphosphonates / therapeutic use*
  • Growth Disorders / drug therapy
  • Humans
  • Osteoporosis / diagnosis
  • Osteoporosis / drug therapy*


  • Bone Density Conservation Agents
  • Diphosphonates