Low doses of pamidronate to treat osteopenia in children with severe cerebral palsy: a pilot study

The aim of this study was to test the efficacy of low doses of pamidronate in increasing bone mineral density (BMD) in non‐ambulatory children and adolescents with cerebral palsy (CP). Twenty‐three non‐ambulatory children and adolescents (12 females, 11 males; mean age 10y [SD 5y], range 4y 1mo‐ 17y 11mo) with severe spastic quadriplegic CP and low BMD were recruited from a multidisciplinary clinic. Severity of CP was graded at Level IV ( n =10) and Level V ( n =13) using the Gross Motor Function Classification System. Patients received intravenous pamidronate (4.12mg/kg/y, maximum 45mg/d) every 4 months. Lumbar spine and femoral neck BMD were measured at baseline and after 4 and 12 months. Twelve months after the first dose of pamidronate there was a significant increase in lumbar spine and femoral neck BMD ( p <0.01 for both sites) and z scores compared with baseline values ( p <0.01 for both sites). Mean BMD z scores increased 1.6 points for femoral neck and 1.9 points for lumbar spine after 12 months of pamidronate treatment. Serum intact parathyroid hormone increased significantly and cross‐linked N‐teleopeptide of type I collagen decreased significantly at 12 months. No significant side effect was noted. Low doses of pamidronate are well tolerated and significantly increase BMD in non‐ambulatory children and adolescents with CP.