Pamidronate improves pain, wellbeing, fracture rate and bone density in 14 children and adolescents with chronic neurological conditions

Objective: To investigate if intravenous pamidronate improves bone density in a cohort of patients with chronic neurological conditions and low bone density, in whom fractures and bone pain are impacting on care. Methods: Fourteen participants (M:F = 7:7, average age 12.4 years) were enrolled in a prospective uncontrolled study in which pamidronate was infused every 6-8 weeks over a 2 year period, the average dose received was 12.5 mg kg(-1). Results: Bone mineral density z-score improved at all sites measured over the 2 years; whole body -4.84 to -3.14 (p = 0.01), lumbar spine -2.92 to -1.1 (p = 0.02) and femoral neck -4.6 to -3.58 (p = 0.04). Of the eight patients with pain at baseline, seven reported decreased pain after 12 months of pamidronate. Of the 11 patients who answered the general wellbeing part of the questionnaire, eight patients reported an improvement in general wellbeing and three reported no change. There was a downward trend in the average annualized fracture rate from 0.42 to 0.14 fractures per year (p = 0.09). Conclusion: Pamidronate improves bone density and reduces pain in children and adolescents with chronic neurological conditions.