Skip to main content
Erschienen in: Pediatric Radiology 1/2012

01.01.2012 | Original Article

Fracture after bisphosphonate treatment in children with cerebral palsy: the role of stress risers

verfasst von: H. Theodore Harcke, Kimberly L. Stevenson, Heidi H. Kecskemethy, Steven J. Bachrach, Leslie E. Grissom

Erschienen in: Pediatric Radiology | Ausgabe 1/2012

Einloggen, um Zugang zu erhalten

Abstract

Background

In the nonambulatory cerebral palsy (CP) population with a prior history of fracture, the use of pamidronate is not always effective in preventing further fractures.

Objective

To test the hypothesis that when fractures occur after cyclic pamidronate, they will be at the proximal or distal end of a pamidronate band.

Materials and methods

Retrospective review of our CP patient database revealed 53 children who had received one or more complete courses of pamidronate therapy (five cycles over 12 months). Medical records were screened to identify children who had sustained a fracture or fractures after completing treatment.

Results

Of 53 patients treated with pamidronate, only 14 sustained fractures after treatment. Radiographs were available for 11 patients, showing 19 fractures. Sixty-three percent of these fractures were located at a junction with pamidronate bands but not within the bands.

Conclusions

We propose stress risers as the mechanism for fractures that have occurred where bone mineral density abruptly changes as a result of cyclic administration of pamidronate. We show a theoretical example of how alternative dosing might reduce the ratio and therefore decrease the chance of formation of a stress riser.
Literatur
1.
Zurück zum Zitat Bachrach SJ, Kecskemethy HH, Harcke HT et al (2010) Decreased fracture incidence after 1 year of pamidronate treatment in children with spastic quadriplegic cerebral palsy. Dev Med Child Neurol 52:837–842PubMedCrossRef Bachrach SJ, Kecskemethy HH, Harcke HT et al (2010) Decreased fracture incidence after 1 year of pamidronate treatment in children with spastic quadriplegic cerebral palsy. Dev Med Child Neurol 52:837–842PubMedCrossRef
2.
Zurück zum Zitat Plotkin H, Bruzoni M, Coughlin S et al (2006) Low doses of pamidronate for the treatment of osteopenia in children with cerebral palsy. Dev Med Child Neurol 48:709–712PubMedCrossRef Plotkin H, Bruzoni M, Coughlin S et al (2006) Low doses of pamidronate for the treatment of osteopenia in children with cerebral palsy. Dev Med Child Neurol 48:709–712PubMedCrossRef
3.
Zurück zum Zitat Bachrach SJ, Kecskemethy HH, Harcke HT et al (2006) Pamidronate treatment and post treatment bone density in children with spastic quadriplegic cerebral palsy. J Clin Densitom 9:167–174PubMedCrossRef Bachrach SJ, Kecskemethy HH, Harcke HT et al (2006) Pamidronate treatment and post treatment bone density in children with spastic quadriplegic cerebral palsy. J Clin Densitom 9:167–174PubMedCrossRef
4.
Zurück zum Zitat Henderson RC, Lark RK, Kecskemethy HH et al (2002) Bisphosphonates to treat osteopenia in children with quadriplegic cerebral palsy: a randomized, placebo-controlled clinical trial. J Pediatr 141:644–651PubMedCrossRef Henderson RC, Lark RK, Kecskemethy HH et al (2002) Bisphosphonates to treat osteopenia in children with quadriplegic cerebral palsy: a randomized, placebo-controlled clinical trial. J Pediatr 141:644–651PubMedCrossRef
5.
Zurück zum Zitat Shaw NJ, White CP, Fraser WD et al (1994) Osteopenia in cerebral palsy. Arch Dis Child 71:235–238PubMedCrossRef Shaw NJ, White CP, Fraser WD et al (1994) Osteopenia in cerebral palsy. Arch Dis Child 71:235–238PubMedCrossRef
6.
Zurück zum Zitat Rauch F, Munns C, Land C et al (2006) Pamidronate in children and adolescents with osteogenesis imperfecta: effect of treatment discontinuation. J Clin Endocrinol Metab 91:1268–1274PubMedCrossRef Rauch F, Munns C, Land C et al (2006) Pamidronate in children and adolescents with osteogenesis imperfecta: effect of treatment discontinuation. J Clin Endocrinol Metab 91:1268–1274PubMedCrossRef
7.
Zurück zum Zitat Marx RE, Sawatari Y, Fortin M et al (2005) Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg 63:1567–1575PubMedCrossRef Marx RE, Sawatari Y, Fortin M et al (2005) Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg 63:1567–1575PubMedCrossRef
8.
Zurück zum Zitat Whyte MP, Wenkert D, Clements KL et al (2003) Bisphosphonate-induced osteopetrosis. N Engl J Med 349:457–463PubMedCrossRef Whyte MP, Wenkert D, Clements KL et al (2003) Bisphosphonate-induced osteopetrosis. N Engl J Med 349:457–463PubMedCrossRef
9.
Zurück zum Zitat Grissom LE, Harcke HT (2003) Radiographic features of bisphosphonate therapy in pediatric patients. Pediatr Radiol 33:226–229PubMed Grissom LE, Harcke HT (2003) Radiographic features of bisphosphonate therapy in pediatric patients. Pediatr Radiol 33:226–229PubMed
10.
Zurück zum Zitat Staheli L (2006) Practice of pediatric orthopedics, 2nd ed. Lipincott, Williams, and Wilkins, Philadelphia p 267 Staheli L (2006) Practice of pediatric orthopedics, 2nd ed. Lipincott, Williams, and Wilkins, Philadelphia p 267
11.
Zurück zum Zitat Alford JW, Bradley MP, Fadale PD et al (2007) Resorbable fillers reduce stress risers from empty screw holes. J Trauma 63:647–654PubMedCrossRef Alford JW, Bradley MP, Fadale PD et al (2007) Resorbable fillers reduce stress risers from empty screw holes. J Trauma 63:647–654PubMedCrossRef
12.
Zurück zum Zitat Miller F, Dabney KW, Rang M et al (1995) Complications in cerebral palsy treatment. In: Epps CH Jr, Bowen JR (eds) Complications in pediatric orthopaedic surgery. Lippincott, Philadelphia Miller F, Dabney KW, Rang M et al (1995) Complications in cerebral palsy treatment. In: Epps CH Jr, Bowen JR (eds) Complications in pediatric orthopaedic surgery. Lippincott, Philadelphia
13.
Zurück zum Zitat Hernandez CJ (2008) How can bone turnover modify bone strength independent of bone mass? Bone 42:1014–1020PubMedCrossRef Hernandez CJ (2008) How can bone turnover modify bone strength independent of bone mass? Bone 42:1014–1020PubMedCrossRef
14.
Zurück zum Zitat Andiran N, Alikasifoglu A, Gone N et al (2008) Cyclic pamidronate therapy in children with osteogenesis imperfecta: results of treatment and follow-up after discontinuation. J Pediatr Endocrinol Metab 21:63–72PubMedCrossRef Andiran N, Alikasifoglu A, Gone N et al (2008) Cyclic pamidronate therapy in children with osteogenesis imperfecta: results of treatment and follow-up after discontinuation. J Pediatr Endocrinol Metab 21:63–72PubMedCrossRef
15.
Zurück zum Zitat Henderson RC, Lark RK, Newman JE et al (2002) Pediatric reference data for dual x-ray absorptiometric measures of bone density in the distal femur. AJR 178:439–443PubMed Henderson RC, Lark RK, Newman JE et al (2002) Pediatric reference data for dual x-ray absorptiometric measures of bone density in the distal femur. AJR 178:439–443PubMed
16.
Zurück zum Zitat Zemel BS, Stallings VA, Leonard MB et al (2009) Revised pediatric reference data for the lateral distal femur measured by dual energy x-ray absorptiometry. J Clin Densitom 12:207–218PubMedCrossRef Zemel BS, Stallings VA, Leonard MB et al (2009) Revised pediatric reference data for the lateral distal femur measured by dual energy x-ray absorptiometry. J Clin Densitom 12:207–218PubMedCrossRef
17.
Zurück zum Zitat Aspenberg P (2009) Bisphosphonates and fatigue fractures. IBMS BoneKEy 6:465–467CrossRef Aspenberg P (2009) Bisphosphonates and fatigue fractures. IBMS BoneKEy 6:465–467CrossRef
18.
Zurück zum Zitat Neviaser AS, Lane JM, Lenart BA et al (2008) Low-energy femoral shaft fractures associated with alendronate use. J Orthop Trauma 22:346–350PubMedCrossRef Neviaser AS, Lane JM, Lenart BA et al (2008) Low-energy femoral shaft fractures associated with alendronate use. J Orthop Trauma 22:346–350PubMedCrossRef
19.
Zurück zum Zitat Ing-Lorenzini K, Desmeules J, Plachta O et al (2009) Low-energy femoral fractures associated with the long-term use of bisphosphonates. Drug Saf 32:775–785PubMedCrossRef Ing-Lorenzini K, Desmeules J, Plachta O et al (2009) Low-energy femoral fractures associated with the long-term use of bisphosphonates. Drug Saf 32:775–785PubMedCrossRef
20.
Zurück zum Zitat Bishop NE, Ferguson S, Tepic S (1996) Porosity reduction in bone cement at the cement-stem interface. J Bone Joint Surg 78B:349–356 Bishop NE, Ferguson S, Tepic S (1996) Porosity reduction in bone cement at the cement-stem interface. J Bone Joint Surg 78B:349–356
21.
Zurück zum Zitat Rauch F, Cornibert S, Cheung M et al (2007) Long-bone changes after pamidronate discontinuation in children and adolescents with osteogenesis imperfecta. Bone 40:821–827PubMedCrossRef Rauch F, Cornibert S, Cheung M et al (2007) Long-bone changes after pamidronate discontinuation in children and adolescents with osteogenesis imperfecta. Bone 40:821–827PubMedCrossRef
22.
Zurück zum Zitat Harcke HT, Taylor A, Bachrach S et al (1998) Lateral femoral scan: an alternative method for assessing bone mineral density in children with cerebral palsy. Pediatr Radiol 28:241–246PubMedCrossRef Harcke HT, Taylor A, Bachrach S et al (1998) Lateral femoral scan: an alternative method for assessing bone mineral density in children with cerebral palsy. Pediatr Radiol 28:241–246PubMedCrossRef
23.
Zurück zum Zitat Ward KA, Adams JE, Freemont TJ et al (2007) Can bisphosphonate treatment be stopped in a growing child with skeletal fragility? Osteoporos Int 18:1137–1140PubMedCrossRef Ward KA, Adams JE, Freemont TJ et al (2007) Can bisphosphonate treatment be stopped in a growing child with skeletal fragility? Osteoporos Int 18:1137–1140PubMedCrossRef
24.
Zurück zum Zitat Gandrud LM, Cheung JC, Daniels MW et al (2003) Low-dose intravenous pamidronate reduces fractures in childhood osteoporosis. J Pediatr Endocrinol Metabol 16:887–892CrossRef Gandrud LM, Cheung JC, Daniels MW et al (2003) Low-dose intravenous pamidronate reduces fractures in childhood osteoporosis. J Pediatr Endocrinol Metabol 16:887–892CrossRef
25.
Zurück zum Zitat Steelman J, Zeitler P (2003) Treatment of symptomatic pediatric osteoporosis with cyclic single-day intravenous pamidronate infusions. J Pediatr 142:417–423PubMedCrossRef Steelman J, Zeitler P (2003) Treatment of symptomatic pediatric osteoporosis with cyclic single-day intravenous pamidronate infusions. J Pediatr 142:417–423PubMedCrossRef
Metadaten
Titel
Fracture after bisphosphonate treatment in children with cerebral palsy: the role of stress risers
verfasst von
H. Theodore Harcke
Kimberly L. Stevenson
Heidi H. Kecskemethy
Steven J. Bachrach
Leslie E. Grissom
Publikationsdatum
01.01.2012
Verlag
Springer-Verlag
Erschienen in
Pediatric Radiology / Ausgabe 1/2012
Print ISSN: 0301-0449
Elektronische ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-011-2198-9

Weitere Artikel der Ausgabe 1/2012

Pediatric Radiology 1/2012 Zur Ausgabe

Editorial

Ownership

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.