Sanjay K. Chilbule and Vrisha Madhuri
Purpose
Pamidronate, used for the treatment of paediatric
osteoporosis, reduces the fracture rate and improves ambulatory status.
Intravenous pamidronate therapy has known complications which have not been
stratified based on its dose and distribution. This study aims to assess the
early minor and major medical and late surgical complications and the effect of
the dose and regimen of infusion on these events in paediatric osteoporosis.
Study design
Retrospective cohort.
Materials and methods
Three regimens for pamidronate infusion were followed in
sequential periods in 10 years. Regimen A delivered 1.5 mg/kg/day as a single
dose once in 3 months. Regimen B delivered 2 mg/kg/day for 3 days twice a year,
while regimen C delivered 1 mg/kg/day for 3 days every 3–4 months. Adverse
events were classified as early (major and minor) or late (surgical).
Results
Forty-eight children received 158 infusions using one of the
three regimens. Twenty-nine complications occurred in 24 children. A significant
difference in the complication rate was present among the three regimens
(P = 0.005). Nineteen children had minor complications, mainly febrile
reaction or asymptomatic hypocalcaemia. Four major complications consisting of
one seizure, one respiratory distress and two hypocalcaemic tetany were
encountered, all with regimen B. Intraoperative complication faced was loss of
position due to splintering of the cortex while rush rodding. This was seen in
20% of the long bone segments operated in those who received pamidronate as
compared to 4.4% of the segments which were operated prior to the initiation of
pamidronate therapy; the odds of splintering were 5.4 times higher for those
patients who were bone segment rodded after pamidronate therapy.
Discussion
Intravenous pamidronate is associated with complications in
50% of children with paediatric osteoporosis, with a dose-dependent significant
difference. Major complications are not uncommon with higher doses and can be
avoided by increasing the number of doses per year and decreasing the dose per
cycle. Surgical difficulty, when possible, can be avoided by correcting any
major deformities at presentation prior to the induction of pamidronate therapy.
observação: O trabalho mostra o alto indice de complicação no tratamento cirúrgico durante o uso de Pamidronato.
