What are Bisphosphonates
Bisphosphonates are a group of drugs that prevent the loss of bone mass. They are used in children who have weak or fragile bones. They are used in a range of low bone mass conditions such as osteogensis imperfecta, prolonged immobility and long term steroid use.
At Leeds we currently use:
Pamidronate – given through a vein
Zoledronate – given through a vein
Risedronate – given orally
How do they work?
There are two main cells within bones:
Osteoblasts – these cells make new bone
Osteoclasts – these cells remove old bone in a process called resorption
These cells work together continuously to make the bone strong in both children and adults. Bisphosphonates stick to the bone and reduce the activity of the osteoclasts so less bone is reabsorbed. Osteoblasts continue their work forming new bone, thus making bones denser and stronger.
What are the benefits?
By improving bone density, the bisphosphonate treatment is thought to reduce the risk of fractures and reduce bone pain. If children have loss the height in the bones of their back it may help restore the shape and size of the vertebrae.
Are there any side-effects?
Pamidronate and Zoledronate have similar side-effects
Pamidronate and Zoledronate have similar side-effects. Itís not uncommon to have ìflu likeî symptoms following the first cycle of treatment. Your child may suffer with a temperature, achy joints and feel generally unwell for a few days. Paracetamol can be given to make your child feel more comfortable during this time. Occasionally it can occur with subsequent infusions.
These side effects can cause extra ëstressí to the children who are being treated with steroids. We therefore recommend a sick day steroid stress dose for 48 hours starting from the morning of the bisphosphonate infusion as per your childs steroid care pan.
This would only usually be needed for the first cycle of treatment. If you did feel particularly unwell during the first infusion, it would be advisable to have another course of steroid stress doses with the next infusion.
Please ensure that you drinks adequately or more than usual for two days starting the day before the infusion. This avoids dehydration and may help in preventing you feeling more unwell.
The NHS Healthy eating for teens recommends around 6 to 8 glasses of fluid a day.
Some children may experience an upset tummy following the first treatment. If this happens please ensure your child has plenty of fluids to drink and contact us for further advice.
Bisphosphonates can lower the calcium level in the body.Following the first treatment your child will be given a short course of calcium medication to take at home. We also encourage a diet rich in calcium including dairy products and cheese.
If any orthopaedic surgery is being planned we may alter the cycles of treatment to ensure the bisphosphonates donít interfere with bone healing after your childís operation.
A rare side-effect reported in adults receiving bisphosphonate treatment is called osteonecrosis of the jaw. This is a condition where the jaw bone becomes exposed (such as following dental extractions). It does not heal and the bone weakens and dies causing pain.
There are no reports of this occurring in children. It is mainly reported in adults with cancers who are also receiving a bisphosphonate. However, as with all children it is recommended your child has good oral hygiene and visits the dentist every six months. It is important to inform your childís dentist they are receiving bisphosphonate treatment.
The oral preparation Risedronate can irritate the oesophagus (food pipe) it is important to follow the instructions on the packet and the information leaflet provided by your team.
How is the treatment given?
Your child will attend the childrenís day care unit where they will have their pulse, temperature and blood pressure checked to ensure they are well enough for the treatment.
Pamidronate and Zoledronate are given as an intravenous infusion. A cannula (small plastic tube) will be inserted into a vein – usually in their hand or arm. Blood tests for calcium and Vitamin D will be taken before every infusion.
Pamidronate is administered over four hours for two consecutive days. The treatment is repeated every three months. The cannula will be secured with a dressing and bandage, and can stay in for both treatments.
Zoledronate is administered over one hour. As it is a more potent drug, only one infusion is required every six months. The child is advised to drink plenty of fluids on the day of treatment.
Risedronate is a tablet that is usually taken once a week. Your team will provide you with information on the dose and frequency of this medication. It should be taken on an empty stomach in the morning with tap water. The child should not lie down or eat anything else for the next hour. Your team can provide you with an information leaflet to advise on how and when to take.
The children’s endocrine metabolic bone team
Dr Talat Mushtaq – Consultant Paediatric Endocrinologist
Dr Nadia Amin – Consultant Paediatric Endocrinologist
Sr Clare Patchett – Children’s Endocrine Nurse Specialist
Sr Joanna Eastman – Children’s Endocrine Nurse Specialist
Daniella Peat – Endocrine Team Administrator
Contact Us
If you have any questions or concerns please contact:
Clare Patchett
Children’s Endocrine Nurse Specialist
Daniella Peat
Secretary for Children’s Endocrine Team