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Treatment With Pamidronate for Osteoporosis Complicating Long-term Intestinal Failure

Pastore, S.*; Londero, M.*; Barbieri, F.*; Di Leo, G.; Paparazzo, R.; Ventura, A.*

Journal of Pediatric Gastroenterology & Nutrition: November 2012 - Volume 55 - Issue 5 - p 615–618
doi: 10.1097/MPG.0b013e31825f1c7d
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ABSTRACT: Long-term home parenteral nutrition (PN) is a potential risk for developing osteoporosis. Various attempts have been made to treat bone disease both by modifying the composition of PN and by administering hormones, such as calcitonin, parathyroid hormone, and sexual hormones. Bisphosphonates are recognized as a medication useful for the treatment of several bone disorders associated with excessive reabsorption. Nevertheless, there have been no paediatric studies on bisphosphonates use for intestinal failure–associated bone disease. Our study includes 6 paediatric patients receiving extremely long-term home PN (at least 3 years) who showed radiological and clinical signs of osteoporosis. Diagnosis of bone disease was made after a median period of 127.5 PN months. Treatment consisted in 2 cycles of intravenous pamidronate, 30 mg/m2 once per month for 6 months consecutively. They all showed a significant improvement in bone mineral density, evaluated after 6 and 12 months of pamidronate treatment. In our sample anthropometrical variables (weight, height, and body mass index) are not related with the z-score trend. Our patients had normal levels of calcium, phosphorus, and vitamin D, and proper nutrient intake. At the last follow-up, dual-energy x-ray absorptiometry scan showed that no patients had a z-score lower than −2.5; moreover, nobody developed bone fractures during the 108-month follow-up. The patients did not have any prominent adverse effect. Finally, in our experience, pamidronate is effective for improving bone mineral density and safe in patients with intestinal failure–associated bone disease.

*Institute for Maternal and Child Health—IRCCS Burlo Garofolo, University of Trieste

Division of Gastroenterology and Nutrition, Institute for Maternal and Child Health—IRCCS Burlo Garofolo

Division of Pharmacology, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, Trieste, Italy.

Address correspondence and reprint requests to Dr Serena Pastore, MD, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, University of Trieste, via dell’Istria 65/1, Trieste 34137, Italy (e-mail: pastore_serena@libero.it).

Received 9 December, 2011

Accepted 16 April, 2012

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN