Pamidronate Treatment and Posttreatment Bone Density in Children With Spastic Quadriplegic Cerebral Palsy

Bachrach, Steven J.; Kecskemethy, Heidi H.; Harcke, H. Theodore; Lark, Robert K.; Miller, Freeman; Henderson, Richard C.

doi:10.1016/j.jocd.2005.11.003

« Previous Next »Journal of Clinical Densitometry
Volume 9, Issue 2 , Pages 167-174, April 2006

Pamidronate Treatment and Posttreatment Bone Density in Children With Spastic Quadriplegic Cerebral Palsy

Steven J. Bachrach
- Department of Pediatrics, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, DE
Heidi H. Kecskemethy
- Nemours Biomedical Research, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, DE
H. Theodore Harcke
- Department of Medical Imaging, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, DE
- Address correspondence to H. Theodore Harcke, MD, Department of Medical Imaging, Alfred I. duPont Hospital for Children, P.O. Box 269, Wilmington, DE 19899.
Robert K. Lark
- Department of Orthopedics, University of North Carolina, Chapel Hill, NC
Freeman Miller
- Department of Orthopaedics, Alfred I. duPont Hospital for Children, Nemours Children's Clinic, Wilmington, DE
Richard C. Henderson
- Department of Orthopedics, University of North Carolina, Chapel Hill, NC
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC

Received 21 September 2005; received in revised form 15 November 2005; accepted 15 November 2005.

Abstract

Little is known about the long-term effects of a course of pamidronate treatment on bone mineral density (BMD) of children with spastic quadriplegic cerebral palsy (SQCP). Nine patients with SQCP who had low bone density and/or history of previous fracture(s) were studied during treatment and more than 1 yr after cyclic pamidronate treatment ended. Over the 12 mo of treatment, spine BMD increases raised average Z-score from −4.0 to −2.8. In the distal femoral metaphysis, BMD increase raised average Z-score from −3.6 to −1.7. Observations posttreatment ranged from 12 to 49 mo. Changes in BMD were variable among individuals. Group spine Z-score an average of 34 mo posttreatment approached pretreatment value. Six of eight patients had final distal femur posttreatment Z-scores the same or better than pretreatment baseline an average of 27.1 mo later. While most but not all gains in BMD were lost over the first 2 yr after treatment, no patient sustained fracture during or after treatment for a cumulative follow-up of more than 27 patient-yr.

Key Words: Bisphosphonates, bone mineral density, DXA, fractures, pediatrics, spastic quadriplegia