Decreased fracture incidence after 1 year of pamidronate treatment in children with spastic quadriplegic cerebral palsy

Dev Med Child Neurol. 2010 Sep;52(9):837-42. doi: 10.1111/j.1469-8749.2010.03676.x. Epub 2010 Jun 22.

Abstract

Aim: 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.

Method: 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).

Interpretation: 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.

MeSH terms

  • Adolescent
  • Age Factors
  • Bone Density / drug effects*
  • Bone Density Conservation Agents / administration & dosage
  • Bone Density Conservation Agents / therapeutic use*
  • Cerebral Palsy / complications*
  • Cerebral Palsy / epidemiology
  • Cerebral Palsy / physiopathology
  • Child
  • Child, Preschool
  • Diphosphonates / administration & dosage
  • Diphosphonates / therapeutic use*
  • Female
  • Fractures, Bone / epidemiology
  • Fractures, Bone / prevention & control*
  • Humans
  • Incidence
  • Male
  • Pamidronate
  • Quadriplegia / complications*
  • Quadriplegia / epidemiology
  • Quadriplegia / physiopathology
  • Retrospective Studies
  • Severity of Illness Index
  • Sex Factors
  • Time Factors
  • Treatment Outcome
  • Young Adult

Substances

  • Bone Density Conservation Agents
  • Diphosphonates
  • Pamidronate