Treatments

Bisphosphonates

Bisphosphonates are medications used to improve bone density and reduce the risk of breaking a bone in patients with osteoporosis. They are also used to treat bone pain, inflammatory bone disease, and high calcium levels.

Names of Bisphosphonates

• Zoledronic (Zometa® and Reclast®) - This is the most common treatment and is given through an IV.
• Pamidronate (Aredia®)  - This less common treatment is also given through an IV.
• Alendronate (Fosamax®) Occasionally, children will be treated with this bisphosphonate taken by mouth.

How Bisphosphonates Work

There are two types of cells in the bone: osteoblasts, which build bones, and osteoclasts, and which break done bone. Bisphosphonates work by killing osteoclast cells. Less osteoclasts means that more bone can form.

Side Effects

Possible side effects from being treated with a bisphosphonate:

• Hypocalcemia (low calcium). Hypocalcemia can cause a seizure or heart problems if not treated
• Hypophosphatemia (low phosphorus)
• Fever
• Muscle and bone pain
• Osteonecrosis of the jaw
• Fracture

Side effects most often happen with the first treatment and are less likely with follow-up treatments.

Additionally, bisphosphonates cross the placenta so they cannot be used in the patients who are pregnant or trying to become pregnant.

What To Expect

If your child is being treated with an IV bisphosphonate (zoledronic acid, pamidronate) he or she may be treated in the Pediatric Treatment Center or in the hospital (if he or she has other medical concerns).

Typically the following will happen:

• Your child will need to be seen by a dentist before a bisphosphonate can be given.
• Your child will have blood drawn a few days before treatment to make sure calcium, vitamin D and kidney functions are sufficient. They may also have a urine test.
• Your child may be asked to take medications including calcium and calcitriol starting the night before the treatment and for several days afterwards.
• Once in the treatment center or hospital, your child will have an IV in place. A numbing cream will be used so it will not hurt as much.
• The medication will be given through the IV – 30 minutes for zoledronic acid, 4 hours for pamidronate. Sometimes a blood or urine test will be done before or after the treatment.
• If being treated in the treatment center, you will be able to go home as soon as the treatment is done.
• If admitted to the hospital, your child will stay for 2-3 days so that the doctors can monitor for side effects.
• Tylenol or ibuprofen are used to help with fevers and bone pain.
• Zofran is used to help with nausea or vomiting.
• Your child will return for treatment every 3-12 months, depending on the need.

If your child is being treated with an oral bisphosphonate (alendronate), your doctor will give you specific instructions on when and how to take the medication.

Other Treatments

Calcium and Vitamin D

Many children with bone problems need to take extra calcium and vitamin D. You and your child will meet with a nutritionist who will take a history of your child’s diet to determine how much calcium and vitamin D they get from eating. If too little calcium or vitamin D is being consumed, they may be prescribed calcium or vitamin D supplements. These are over the counter medications and come in many forms, your nutritionist will give you a handout to help you understand which supplements to use.

Physical Therapy

Many children with bone problems will also need to see a physical therapist. They will work to improve your child’s muscle and bone strength through exercise. These visits sometimes happen in clinic, but other times can happen at school or home. Sometimes they will recommend that your child wear a brace or orthotics to help keep the bones in good alignment.
Some children with bone problems will need surgery to fix broken bones or strengthen weak bones. This will be done by an orthopedic surgeon.