Consensus guidelines on the use of bisphosphonate therapy in children and adolescents

Peter J Simm; Andrew Biggin; Margaret R Zacharin; Christine P Rodda; Elaine Tham; Aris Siafarikas; Craig Jefferies; Paul L Hofman; Diane E Jensen; Helen Woodhead; Justin Brown; Benjamin J Wheeler; Denise Brookes; Antony Lafferty; Craig F Munns; APEG Bone Mineral Working Group

doi:10.1111/jpc.13768

Consensus guidelines on the use of bisphosphonate therapy in children and adolescents

J Paediatr Child Health. 2018 Mar;54(3):223-233. doi: 10.1111/jpc.13768.

Authors

Peter J Simm^{1

2

3}, Andrew Biggin^{4

5}, Margaret R Zacharin^{1

2

3}, Christine P Rodda^{3

6

7}, Elaine Tham⁸, Aris Siafarikas^{9

10

11

12}, Craig Jefferies¹³, Paul L Hofman¹⁴, Diane E Jensen^{15

16}, Helen Woodhead^{17

18

19}, Justin Brown^{20

21}, Benjamin J Wheeler²², Denise Brookes¹⁶, Antony Lafferty^{23

24}, Craig F Munns^{4

5}; APEG Bone Mineral Working Group

Affiliations

¹ Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia.
² Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
³ Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
⁴ Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
⁵ Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.
⁶ Australian Institute for Musculoskeletal Research, Sunshine Hospital, Melbourne, Victoria, Australia.
⁷ Department of Paediatrics, Sunshine Hospital, Melbourne, Victoria, Australia.
⁸ Department of Endocrinology and Diabetes, Women's and Children's Hospital, Adelaide, South Australia, Australia.
⁹ Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, Western Australia, Australia.
¹⁰ School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.
¹¹ Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.
¹² Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia.
¹³ Department of Endocrinology and Diabetes, Starship Children's Health, Auckland, New Zealand.
¹⁴ Liggins Institute, University of Auckland, Auckland, New Zealand.
¹⁵ Children's Health Queensland, Hospital and Health Services District, South Brisbane, Queensland, Australia.
¹⁶ Centre for Children's Health Research, University of Queensland, Brisbane, Queensland, Australia.
¹⁷ Department of Endocrinology and Diabetes, Sydney Children's Hospital, Sydney, New South Wales, Australia.
¹⁸ Department of Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, New South Wales, Australia.
¹⁹ School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
²⁰ Department of Paediatric Endocrinology, Monash Children's Hospital, Melbourne, Victoria, Australia.
²¹ Department of Paediatrics, Monash University, Melbourne, Victoria, Australia.
²² Women's and Children's Health, University of Otago, Dunedin, New Zealand.
²³ Department of Paediatrics, Canberra Hospital, Canberra, Australian Capital Territory, Australia.
²⁴ Department of Paediatrics and Child Health, Australian National University Medical School, Canberra, Australian Capital Territory, Australia.

PMID: 29504223
DOI: 10.1111/jpc.13768

Abstract

Bisphosphonate therapy is the mainstay of pharmacological intervention in young people with skeletal fragility. The evidence of its use in a variety of conditions remains limited despite over three decades of clinical experience. On behalf of the Australasian Paediatric Endocrine Group, this evidence-based consensus guideline presents recommendations and discusses the graded evidence (using the GRADE system) for these recommendations. Primary bone fragility disorders such as osteogenesis imperfecta are considered separately from osteoporosis secondary to other clinical conditions (such as cerebral palsy, Duchenne muscular dystrophy). The use of bisphosphonates in non-fragility conditions, such as fibrous dysplasia, avascular necrosis, bone cysts and hypercalcaemia, is also discussed. While these guidelines provide an evidence-based approach where possible, further research is required in all clinical applications in order to strengthen the recommendations made.

Keywords: bone health; fracture; skeletal fragility.

Publication types

Practice Guideline

MeSH terms

Adolescent
Bone Density / drug effects
Bone Density Conservation Agents / adverse effects
Bone Density Conservation Agents / therapeutic use*
Cerebral Palsy / complications
Child
Diphosphonates / adverse effects
Diphosphonates / therapeutic use*
Humans
Muscular Dystrophy, Duchenne / complications
Osteogenesis Imperfecta / drug therapy*
Osteoporosis / drug therapy*
Osteoporosis / etiology

Substances

Bone Density Conservation Agents
Diphosphonates