Intervention Review

Bisphosphonate therapy for children and adolescents with secondary osteoporosis

  1. Leanne Ward1,*,
  2. Andrea Tricco2,
  3. Phuc-Nhi Phuong3,
  4. Ann Cranney4,
  5. Nick Barrowman5,
  6. Isabelle Gaboury6,
  7. Frank Rauch7,
  8. Peter Tugwell8,
  9. David Moher9

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 17 OCT 2007

Assessed as up-to-date: 16 AUG 2007

DOI: 10.1002/14651858.CD005324.pub2

How to Cite

Ward L, Tricco A, Phuong PN, Cranney A, Barrowman N, Gaboury I, Rauch F, Tugwell P, Moher D. Bisphosphonate therapy for children and adolescents with secondary osteoporosis. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005324. DOI: 10.1002/14651858.CD005324.pub2.

Author Information

  1. 1

    Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada

  2. 2

    University of Ottawa, PhD Program in Population Health, Ottawa, Ontario, Canada

  3. 3

    Children's Hospital of Eastern Ontario, Pediatric Bone Research Program, Ottawa, Ontario, Canada

  4. 4

    Ottawa Hospital, Division of Rheumatology, Ottawa, Ontario, Canada

  5. 5

    Children's Hospital of Eastern Ontario Research Insitute, Clinical Research Unit, Ottawa, Ontario, Canada

  6. 6

    Children's Hospital of Eastern Ontario, Clinical Research Unit, Ottawa, Ontario, Canada

  7. 7

    Shriners Hospital for Children, Genetics Unit, Montreal, Québec, Canada

  8. 8

    Ottawa Hospital, Centre for Global Health, Institute of Population Health, Department of Medicine, Ottawa, Ontario, Canada

  9. 9

    Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

*Leanne Ward, Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario, 401 Smyth Rd., Research Institute, R250H, Ottawa, Ontario, K1H 8L1, Canada.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 17 OCT 2007




  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要


Children with chronic illnesses are at increased risk for reductions in bone strength and subsequent fractures (osteoporosis), either due to the impact of the underlying condition on skeletal development or due to the osteotoxic effect of medications (e.g., glucocorticoids) used to treat the chronic illness. Bisphosphonates are being administered with increasing frequency to children with secondary osteoporosis; however, the efficacy and harm of these agents remains unclear.


To examine the efficacy and harm of bisphosphonate therapy in the treatment and prevention of secondary osteoporosis in children and adolescents.

Search methods

We searched the Cochrane Central Register of Controlled Trials (Issue 4, 2006), MEDLINE, EMBASE, CINAHL and ISI Web of Science (inception-December 2006). Further literature was identified through expert contact, key author searches, scanning reference lists of included studies, and contacting bisphosphonate manufacturers.

Selection criteria

Randomized, quasi-randomized, controlled clinical trials, cohort, and case controls of bisphosphonate(s) in children 0-18 years of age with at least one low-trauma fracture event or reductions in bone mineral density in the context of secondary osteoporosis.

Data collection and analysis

Two reviewers independently extracted data and assessed quality. Case series were used for supplemental harms-related data.

Main results

Six RCTs, two CCTs, and one prospective cohort (n=281 children) were included and classified into osteoporosis due to: 1) neuromuscular conditions (one RCT) and 2) chronic illness (five RCTs, two CCTs, one cohort). Bisphosphonates examined were oral alendronate, clodronate, and intravenous (IV) pamidronate. Study quality varied. Harms data from 23 case series (n=241 children) were used.

Heterogeneity precluded statistically combining the results. Percent change or Z-score change in lumbar spine areal BMD from baseline were consistently reported. Two studies carried out between-group analyses; one showed no significant difference (using oral alendronate in anorexia nervosa) while the other demonstrated a treatment effect on lumbar spine with IV pamidronate in burn patients. Frequently reported harms included the acute phase reaction, followed by gastrointestinal complaints, and bone/muscle pain.

Authors' conclusions

The results justify further evaluation of bisphosphonates among children with secondary osteoporosis. However, the evidence does not support bisphosphonates as standard therapy. Short-term (3 years or less) bisphosphonate use appears to be well-tolerated. An accepted criterion for osteoporosis in children, a standardized approach to BMD reporting, and examining functional bone health outcomes (e.g., fracture rates) will allow for appropriate comparisons across studies.


Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要

Bisphosphonate therapy for children and adolescents with secondary osteoporosis.

This summary of a Cochrane review presents what we know from research about the effect of bisphosphonates for osteoporosis in children and adolescents. The review shows that bisphosphonates:

- may not lead to any difference in bone mineral density (bone thickness and strength).

There was not enough information in the included studies to tell whether bisphosphonates would make a difference to children's bone mineral content (the amount and type of minerals in the bone); the number of broken bones children and adolescents had or the condition of children's vertebrae (for example, new fractures detected on an x-ray or other scan).

We often do not have precise information about side effects and complications. This is particularly true for rare but serious side effects. Possible side effects may include the acute phase reaction (fever, chills, general malaise), low levels of calcium in the body, nausea, abdominal bloating and other digestion problems, damage to the esophagus, bone or muscle pain, dizziness, rash, and memory loss.

What is osteoporosis and what are bisphosphonates?
Bone is a living, growing part of your body. Throughout your lifetime, new bone cells grow and old bone cells break down to make room for the new, stronger bone. When you have osteoporosis, the old bone breaks down faster than the new bone can replace it. As this happens, the bones lose minerals (such as calcium). This makes bones weaker and more likely to break even after a minor injury, like a little bump or fall. All the bones in your body are weaker if you have osteoporosis but not everyone who has osteoporosis gets a broken bone.

To find out whether a person's bones are weaker than normal, a bone mineral density test is done using a special x-ray, a computed tomography (CT) scan or an ultrasound.
In some children with a chronic illness, osteoporosis could be caused by condition they have or because of the medications they take for their condition. This is known as secondary osteoporosis.

Bisphosphonates are a type of medication that slows down the cells that break down the old bone. This means the cells that grow new bone have a chance to catch up and strengthen the bone.



  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要







Cochrane Central Register of Controlled Trials(2006年第4号)、MEDLINE、EMBASE、CINAHLおよびISI Web of Science(開始-2006年12月)を検索した。専門家への問い合わせ、主要な著者の検索、含まれる研究の参照文献リストの精査、およびビスホスホネート製造業者への問い合わせを通じて、さらなる文献を同定した。










監  訳: 曽根 正好,2008.1.11

実施組織: 厚生労働省委託事業によりMindsが実施した。

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  1. Top of page
  2. Abstract
  3. Plain language summary
  4. アブストラクト
  5. 摘要







搜尋包括Cochrane Central Register of Controlled Trials (Issu, 2006), MEDLINE, EMBASE, CINAHL and ISI Web of Science (inceptionDecembe 006)。同時搜尋所選文章之參考文獻,並詢問專家、關鍵研究者及製造廠商以獲得更多文獻。






6個隨機對照試驗研究,2個擬隨機對照試驗,1個前瞻世代研究﹝281例兒童病患﹞,並區分病因為神經肌肉疾病(1 隨機對照研究) 及慢性病(5隨機對照研究,2病例對照研究,1世代研究)。雙磷酸鹽類藥物包括口服alendronate, clodronate及靜脈注射pamidronate。各研究品質差異大。副作用相關資料由23病例系列(241例兒童病患)分析。因異質性而無法統合分析。各研究報告腰椎骨質密度之改變百分比或Z分數。2研究作組間分析,其中之一研究口服alendronate治療厭食症患者之骨質疏鬆發現並無顯著差異,另一研究燙傷患者靜脈注射pamidronate發現有顯著差異。較常見報告副作用有急性注射反應、胃腸不適、骨肌肉疼痛。





此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。


雙磷酸鹽類藥物(Bisphosphonate)治療兒童及成人續發性骨質疏鬆症。此Cochrane回顧摘要了我們所知道有關雙磷酸鹽類藥物(Bisphosphonate)治療兒童及成人骨質疏鬆症的效果。該回顧顯示雙磷酸鹽; 可能不會導致任何骨密度(骨厚度和強度)的差異。在納入的研究中沒有足夠的資訊可判斷是否雙磷酸鹽對兒童的骨礦含量(骨中礦物質數量和類型)、兒童和青少年骨折的數目或兒童脊椎的狀況(例如,X射線或其他掃描下新發現的骨折)會有所作為。我們往往沒有確切關於副作用和併發症的資訊。尤其是罕見但嚴重的副作用。可能的副作用可能包括急性期反應(發燒,寒戰,全身不適),體內低濃度鈣,噁心,腹脹等消化問題,損害食道,骨骼或肌肉疼痛,頭暈,皮疹和記憶喪失。什麼是骨質疏鬆症和雙磷酸鹽是什麼?骨頭是活的,你的身體成長的一部分。在你整個一生中,新的骨細胞生長和舊的骨細胞破壞並提供空間給新的,更強的骨頭。當你有骨質疏鬆症,舊的骨質分解速度快於新骨代替。由於這種情況,骨頭流失礦物質(如鈣)。這使得骨頭較弱,更容易斷掉,即使輕微的損傷,像一個小的碰撞或跌倒。如果你有骨質疏鬆症,所有你體內的骨頭都較脆弱,但不是每個有骨質疏鬆症的人都會骨折。要找出是否一個人的骨頭是弱於正常,骨質密度測試是通過使用一種特殊的X光,電腦斷層掃描(CT)掃描或超聲波。在一些有慢性疾病的小孩,可能是由於他們的條件,或因為為了他們狀況而使用的藥物造成了骨質疏鬆症。這被稱為繼發性骨質疏鬆。 雙磷酸鹽是一種藥物,減慢細胞破壞舊的骨頭。這意味著新骨細胞的生長有機會趕上和強化骨骼。這是一個由Cochrane合作的定期更新系統性回顧試驗總結。全文回顧可在Cochrane Library 取得。