Bisphosphonate treatment for skeletal complications in paediatric cancer-Experience from a single tertiary centre

Acta Paediatr. 2024 Jun;113(6):1446-1452. doi: 10.1111/apa.17143. Epub 2024 Feb 8.


Aims: The aim was to analyse the use and safety of bisphosphonate treatment for metabolic bone complications in paediatric cancer patients.

Methods: We retrospectively describe our experience with bisphosphonate treatment in 25 childhood cancer patients (aged <18 years) in a single tertiary hospital between 1999 and 2020.

Results: The most common primary diagnosis was acute lymphoblastic leukaemia (n = 16) and Hodgkin lymphoma (n = 3). Eleven patients (44%) had received allogeneic stem cell transplantation and two patients autologous stem cell transplantation. Sixteen patients (64%) had been treated with radiotherapy, either total-body (n = 11) or local (n = 5). The main indication for bisphosphonates was osteoporosis with vertebral compression fractures in 13/25, osteonecrosis in 6/25 and hypercalcaemia in 2/25. The bisphosphonate treatment was started on average 13 (range 0-76) months after the diagnosis of the bone complication. Bisphosphonate treatment lasted between weeks (hypercalcaemia) to 5 years (severe osteoporosis). Mild, non-symptomatic hypophosphatemia (n = 8), hypocalcaemia (n = 6) and moderate, transient pain (n = 6) were the most common adverse effects. No severe side effects were observed even when bisphosphonates were administered concomitantly with chemotherapy. Bone mineral density significantly improved with the bisphosphonate treatment (mean lumbar spine Z-score -1.17 vs. -0.07, p < 0.001).

Conclusion: Bisphosphonate treatment was well tolerated in this paediatric patient cohort.

Keywords: bisphosphonate; bone; cancer; leukaemia; skeletal complication.

MeSH terms

  • Adolescent
  • Bone Density Conservation Agents* / adverse effects
  • Bone Density Conservation Agents* / therapeutic use
  • Bone Diseases, Metabolic / drug therapy
  • Bone Diseases, Metabolic / etiology
  • Child
  • Child, Preschool
  • Diphosphonates* / adverse effects
  • Diphosphonates* / therapeutic use
  • Female
  • Humans
  • Infant
  • Male
  • Neoplasms / complications
  • Osteoporosis / drug therapy
  • Retrospective Studies
  • Tertiary Care Centers*


  • Diphosphonates
  • Bone Density Conservation Agents