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Pharmacy Practice Resident, Children's Hospital, Birmingham, AL
Associate Professor of Pharmacy Practice, Samford University McWhorter School of Pharmacy; Pediatric Clinical Pharmacy Specialist, Children's Hospital, Birmingham
Pediatric Hematology/Oncology Clinical Pharmacy Specialist, Children's Hospital, Birmingham
Reprints: Dr. Bryant, Department of Pharmacy, Children's Health System, 1600 Seventh Ave. South, Birmingham, AL 35233, fax 205/726-2669 (attn: Dr. Mary Worthington), michele.bryant{at}chsys.org
OBJECTIVE: To evaluate the efficacy and safety of various treatment options for osteopenia and osteoporosis secondary to cancer treatment in pediatric patients undergoing cancer therapy.
DATA SOURCES: A systematic search of PubMed (1949-November 2008) and International Pharmaceutical Abstracts (to November 2008) was conducted using the following search terms: osteoporosis, osteopenia, pediatrics, cancer, neoplasms, chemotherapy, bisphosphonates, calcium, vitamin D, calcitonin, and physical therapy.
STUDY SELECTION AND DATA EXTRACTION: All prospective studies that evaluated various osteoporosis treatment options in pediatric patients undergoing chemotherapy were included. Results from studies evaluating bisphosphonates and other treatments in children with osteoporosis due to other causes were also included if important safety and efficacy data were provided. Most commonly reported primary efficacy endpoints included comparisons of bone density parameters measured before and after treatment.
DATA SYNTHESIS: Four clinical studies and 2 case reports describing treatment with bisphosphonates, specifically alendronate and pamidronate, for osteoporosis or osteopenia in pediatric cancer patients were identified. Results from the trials showed that these medications were efficacious in reducing bone mineral density loss during cancer therapy and were well tolerated in this special population. Primary efficacy endpoints included improvements in Z-scores measured by dual-energy X-ray absorptiometry scans. The most commonly reported adverse effects included hypocalcemia, mild stomach upset, and infusion-related hyperpyrexia. Four additional clinical trials involving the treatment of osteoporosis or osteopenia in children and adolescents who developed bone degeneration after chronic steroid therapy are also included. In these trials, treatment options such as calcitonin, and calcium and vitamin D supplementation were also shown to be beneficial.
CONCLUSIONS: The clinical trials published to date are limited to only a few conducted in small populations of patients diagnosed with lymphoblastic leukemia or non-Hodgkin's lymphoma. However, alendronate and pamidronate both appeared to be effective options in improving bone mineral density scores with minimal adverse effects.
Key Words: bisphosphonates, calcium, cancer therapy, osteopenia, pediatrics, osteoporosis, vitamin D
Published Online, March 31, 2009. www.theannals.com, DOI 10.1345/aph.1L567
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