Treatment With Pamidronate For Osteoporosis Complicating Long-Term Intestinal Failure

Long term home parenteral nutrition (PN) is at potential risk for developing osteoporosis. Various attempts have been made to treat bone disease both by modifying the composition of parenteral nutrition and administering hormones, such as calcitonin, parathyroid hormone and sexual hormones. Bisphosphonates are recognized as a medication useful for the treatment of several bone disorders associated with excessive reabsorption. Nevertheless, there have been no paediatric studies on bisphosphonates use for intestinal failure associated bone disease.Our study includes 6 paediatric patients on very long term home parenteral nutrition (at least 3 years) that showed radiological and clinical signs of osteoporosis. Diagnosis of bone disease was made after a median period of 127.5 PN months. Treatment consisted in two cycles of intravenous pamidronate, 30 mg/m2 once a month for six months consecutively. They all showed a significant improvement in bone mineral density evaluated after 6 and 12 months of pamidronate treatment.In our little sample anthropometrical variables (weight, height, body mass index) are not related with the Z score trend. Our patients had normal levels of calcium, phosphorus and vitamin D and proper nutrient intake. At the last follow up, DXA scan showed that no patients had Z score below - 2.5; moreover nobody developed bone fractures during the 108-month-follow up.The patients did not have prominent adverse effect. Finally, in our experience, pamidronate is effective for improving bone mineral density and safe in patients with intestinal failure associated bone disease