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Questions around use of bisphosphonates for paediatric bone disease The role of bisphosphosphonates has been expanded to include children through off-label use for osteoporotic or lytic conditions including osteogenesis imperfecta (OI), fibrous dysplasia, juvenile osteoporosis, Gaucher's disease and steroid-induced osteoporosis. What is emerging now, albeit from anecdotal reports from medical and surgical specialists (who have operated on treated children and comment on the nature of the bone) is that there may in fact be deleterious effects of this treatment. Whereas early outcome studies indicated that the body's response to bisphosphonate treatment for the abovementioned conditions was positive and associated with less osteolysis and/or restoration of bone to normal strength and flexibility, some recent experiences suggest that there might be dose and/or duration effects which result in bones converting from conditions of extreme weakness to those of extreme brittleness. As stated, most of the existing literature is positive and several articles cover a number of years of continuous treatment, however the anecdotal reports were regarded as important enough to warrant publication and comment in the New England Journal of Medicine, and one should probably note the alert which has been sounded. Read more: N Engl J Med 2003;349:423-6 457-63 J Clin Invest 2002;110:1293-9 |