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New studies are needed to assess bisphosphonate treatment in children with cerebral palsy
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New studies are needed to assess bisphosphonate treatment in children with cerebral palsy
How effective and safe is bisphosphonate therapy for treating low bone mineral density in children with cerebral palsy?
There is very-low-certainty evidence to suggest that, compared with placebo or no treatment, bisphosphonate therapy may improve bone mineral density (BMD) in the lumbar spine and distal femur in children with cerebral palsy.
Evidence from 1 study showed improved BMD z‐scores at 6 months post‐intervention in the lumbar spine, femur region 1 (metaphysis just proximal to the growth plate) and femur region 2 (region of transition between the broad metaphysis and narrow femoral shaft), but not in femur region 3 (distal portion of the femoral diaphysis).
There is no available evidence that shows whether bisphosphonate treatment may reduce fracture frequency or improve bone pain and quality of life in this population. Minimal adverse effects were reported following 12 months of bisphosphonate treatment.
This review included 2 small randomised controlled trials, with a total sample size of 34 participants. As both studies used different comparators, review authors were unable to combine results.
Both studies were carried out over 10 years ago. In recent years, several other therapies to improve BMD in children with cerebral palsy have been investigated, including weight‐bearing activities and vitamin D supplementation, with or without calcium. The relative efficacy of bisphosphonates must now be assessed in the context of recent evidence reported from other interventions.
Osteoporosis is common in people with cerebral palsy. This leads to poor bone strength and a high risk of fractures, even from very modest trauma. Children with cerebral palsy who are unable to walk are at particularly high risk of poor bone strength and fractures in the leg bones. Bisphosphonates are a group of medications demonstrated to improve bone strength in adults.
Hurley T, et al. Bisphosphonate use in children with cerebral palsy. Cochrane Database Syst Rev 2021;7:CD012756. This review contains 2 trials with a total of 34 participants.