Cerebral Palsy and bisphosphonates - and what can be learned from other types of secondary osteoporosis in children: a scoping review

TY - JOUR

T1 - Cerebral Palsy and bisphosphonates - and what can be learned from other types of secondary osteoporosis in children

T2 - a scoping review

AU - Granild-Jensen, Jakob B

AU - Pedersen, Line K

AU - Langdahl, Bente

AU - Starup-Linde, Jakob

AU - Rackauskaite, Gija

AU - Farholt, Stense

AU - Søndergaard, Charlotte

AU - Vestergaard, Esben T

AU - Møller-Madsen, Bjarne

N1 - This article is protected by copyright. All rights reserved.

PY - 2023/4

Y1 - 2023/4

N2 - AIM: We aimed to improve bone health management of children with Cerebral Palsy (CP) by reviewing studies investigating bisphosphonate therapy in children with CP and other types of secondary osteoporosis.METHODS: We included trials on bisphosphonate treatment reporting any direct bone measurement or fracture outcome. All studies of patients with CP were included. We also included all controlled trials of children with secondary bone fragility as well as observational studies with ≥20 participants or at least three years of follow-up. Studies were assessed according to PRISMA guidelines using the RoB2-tool and the Newcastle-Ottawa Scale.RESULTS: We reviewed 1,004 studies and found 38 eligible. Some studies were sufficiently homogeneous to include in a meta-analysis and we found a one-year effect on lumbar spine bone mineral density (BMD) Z-score of +0.65 after oral and +1.21 after intravenous bisphosphonates in children with secondary osteoporosis. Further, data on adverse events and post-treatment follow-up were reviewed. Limitations were heterogeneity and small size of the included studies.CONCLUSION: Meta-analysis consistently showed significant BMD increases with bisphosphonates in children with secondary osteoporosis. Direct evidence of the effect of bisphosphonates on reducing fractures is lacking. We found no reports of long-term adverse events yet longer studies are needed.

AB - AIM: We aimed to improve bone health management of children with Cerebral Palsy (CP) by reviewing studies investigating bisphosphonate therapy in children with CP and other types of secondary osteoporosis.METHODS: We included trials on bisphosphonate treatment reporting any direct bone measurement or fracture outcome. All studies of patients with CP were included. We also included all controlled trials of children with secondary bone fragility as well as observational studies with ≥20 participants or at least three years of follow-up. Studies were assessed according to PRISMA guidelines using the RoB2-tool and the Newcastle-Ottawa Scale.RESULTS: We reviewed 1,004 studies and found 38 eligible. Some studies were sufficiently homogeneous to include in a meta-analysis and we found a one-year effect on lumbar spine bone mineral density (BMD) Z-score of +0.65 after oral and +1.21 after intravenous bisphosphonates in children with secondary osteoporosis. Further, data on adverse events and post-treatment follow-up were reviewed. Limitations were heterogeneity and small size of the included studies.CONCLUSION: Meta-analysis consistently showed significant BMD increases with bisphosphonates in children with secondary osteoporosis. Direct evidence of the effect of bisphosphonates on reducing fractures is lacking. We found no reports of long-term adverse events yet longer studies are needed.

KW - bisphosphonate

KW - bone mineral density

KW - cerebral palsy

KW - children

KW - secondary osteoporosis

U2 - 10.1111/apa.16671

DO - 10.1111/apa.16671

M3 - Review

C2 - 36644940

SN - 0803-5253

VL - 112

SP - 617

EP - 629

JO - Acta paediatrica (Oslo, Norway : 1992)

JF - Acta paediatrica (Oslo, Norway : 1992)

IS - 4

ER -