Bone disease in young patients on long-term parenteral nutrition: The role of pamidronate

The purpose of our study was to investigate the possible therapeutic effects of endovenous infusions of pamidronate in young patients on total parenteral nutrition (TPN) from birth. We examined 9 patients, 6 of whom presented low bone mineral density (BMD). These patients (5 males and 1 female, aged 2 to 19 years) were treated with monthly infusions of pamidronate for six consecutive months. Four patients showed improvement in BMD after pamidronate treatment, one patient's BMD was unchanged, while one patient's BMD worsened. The biochemical markers of bone turnover were not particularly different before and after pamidronate treatment, except for an increase in urinary calcium loss. The only side effect of note was hypocalcemia 1-2 days after infusion, corrected by i.v. calcium supplementation. Our preliminary data seem to indicate that pamidronate is an effective and fairly safe treatment for bone disease in patients on long-term parenteral nutrition. Pamidronate now needs to be administered for longer periods and more cases need to be recruited and monitored.