Bisphosphonate applications in children's orthopaedics

Abstract

Bisphosphonates are chemical compounds which mainly act on bone metabolism by inhibiting bone resorption. Their main indication is currently the treatment of postmenopausal osteoporosis, but they can also be used in other diseases that involve an increase in bone resorption. They have been shown to be beneficial in some paediatric diseases, such as osteogenesis imperfecta, particularly in the more severe forms, polyostotic fibrous dysplasia, patients with severe neuromuscular involvement, and corticosteroid-induced osteoporosis. New indications are also being studied experimentally, such as in Perthes disease or bone lengthening by distraction osteogenesis. Although experience with bisphosphonates in these diseases is limited, and there is also little consensus as regards the most suitable type of bisphosphonate, the dose to use, the form of administration and on the duration of treatment. The long-term secondary effects are still not well known, so caution must be used when using them in growing patients and particularly in girls when reaching fertile age.