Outcomes of zoledronic acid use in paediatric conditions

Objectives: Intravenous bisphosphonates have been used in children for various primary and secondary bone fragility disorders for three decades but beyond osteogenesis imperfecta, there is very limited information published in relation to outcomes. We report the experience at the Royal Children’s Hospital (RCH), Melbourne using Zoledronic acid (ZA), describing outcomes based on the underlying condition for which treatment was given, with the aim of informing future protocols and guidelines for bisphosphonate use.

Methods: A retrospective review of all RCH patients administered at least one dose of intravenous ZA from 2002–2015 was undertaken. All outcome data was collected from existing hospital medical records.

Results: In the 13 years of ZA use, 325 children had at least one dose of ZA; 12 of these were excluded from study inclusion due to either missing documentation regarding use of ZA or indications of extreme prematurity, renal osteodystrophy or intra-arterial calcification. Children included in this review were not taking any other bisphosphonates. Of the 313 patients, Table 1 describes preliminary data outcomes grouped for each condition; more analysis is currently being done on changes per year and after first year of treatment. Mild to moderate first dose acute phase reaction occurred in most with symptomatic acute day 2 hypocalcaemia in several who had steroid induced osteoporosis.