A Cochrane review [Abstract] 1 included 6 RCTs, 2 controlled clinical trials, and 1 prospective cohort study with a total of 281 children. In addition, harms data from 23 case series (n=241 children) were used. Bisphosphonates examined were oral alendronate, clodronate, and intravenous (IV) pamidronate. Heterogeneity prevented pooling of the results. Only two studies carried out between-group analyses post-treatment; one (n=32) showed no significant difference (using oral alendronate in anorexia nervosa) while the other (n=43) demonstrated a treatment effect on lumbar spine with IV pamidronate in burn patients. Frequently reported harms included the acute phase reaction, followed by gastrointestinal complaints, and bone/muscle pain.
Comment: The quality of evidence in downgraded by study quality (inadequate or unclear allocation concealment), by inconsistency (heterogeneity in interventions and outcomes; variability in results across studies) and by imprecise results (limited study size for each comparison). On the other hand, the favourable short-term profile of bisphosphonate agents and preliminary positive effects on BMD and pain reduction may justify their use in severe cases where there is clinical evidence for bone fragility that significantly impacts patient quality of life.
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