AB0845 EFFECTIVENESS AND SAFETY OF BISPHOSPHONATES IN THE TREATMENT OF SECONDARY OSTEOPOROSISIN CHILDREN
Authors: Julia Ferrero Turrión, Rocío Galindo Zavala, Esmeralda Núñez Cuadros, Gisela Diaz-Cordobes, Laura Martín Pedraz, Antonio Urda Cardona
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Prevalence of secondary osteoporosis (SO) in children is an ongoing challenge, due to the rise in life expectancy of chronic diseases and the bone toxicity medication usage. Bisphosphonates (BF) has been stated as an alternative therapy, although studies targeted children are few. <h3>Objectives</h3> The goal was to establish the effectiveness and safety of bisphosphonate therapy in children with SO. <h3>Methods</h3> A retrospective study of BF treatment in children (≤16 years) with SO at a Pediatric Reumathology Unit from 2015 to 2018. Descriptive statistics were performed to examine anthropometric measurements, clinical features, diagnoses and treatment received. We measured bone mineral density by dual-energy x-ray absorptiometry and we expressed the results as adjusted for height-for-age Z-score (HAZ). We assessed the treatment outcome by the change of HAZ after a year treatment and the decreasing fractures rate per year. Afterwards we made a bivariate analysis to identify related factors with effectiveness and safety of bisphosphonates. Values of p&lt;0,1 were considered statistically significant. <h3>Results</h3> In our study 12 patients were treated with BF, three of them with two different type. Table 1 shows the descriptive data. The HAZ and the fracture rate per year after a year of treatment were significantly lower [(-2,22±1,46) vs (-1,06±1,27); p=0,04, and (1 (0,5-2) vs 0 (0-0); p&lt; 0,01), respectively]. The change at HAZ and the before treatment fractures rate per year (r:0,57; p=0,07) were directly proportional. Also, the change at HAZ was inversely proportional to the before treatment Z-score (r: -0,53; p=0,09) and the BF starting age (r: -0,53; p: 0,09). The decrement of fractures rate per year showed a statistical significant relationship with BMI percentile (r:0,48; p=0,08), the treatment starting age (r:-0,537; p=0,05) and before treatment fractures rate per year (r:0,941; p&lt;0,001). Three patients experienced adverse effects (20%). Three related to zoledronate use: two of them showed flu-like syndrome after first infusion and the other asymptomatic hypocalcemia. In another patient the treatment with alendronate was ended due to gastrointestinal intolerance. There was not significant relationship between adverse effects and our study variables. Two patients died during the treatment due to their underlying disease complications. <h3>Conclusion</h3> BF are an effective medication for SO. The treatment outcome exhibits to be better with a good nutritional status, younger age and at more severe forms of the disease. Additionally, they are safe showing just minor adverse effects but often. <h3>References</h3> [1] Galindo Zavala R, Núñez Cuadros E, Díaz Cordovés-Rego G., Urda Cardona, AL. Advances in the treatment of secondary osteoporosis. An Pediatr (Barc). 2014; 81(6): 399.e1-399.e7. [2] Zemel BS, et al. Height adjustment in assessing dual energy x-ray absorptiometry measurements of bone mass and density in children. J Clin Endocrinol Metab.2010; 95(3): 1265–73. [3] Gordon CM, Leonard MB, Zemel BS. 2013pediatric position development conference: Executive summary and reflections. J Clin Densitom. 2014;17(2): 219–24. <h3>Disclosure of Interests</h3> Julia Ferrero Turrión: None declared, Rocío Galindo Zavala Grant/research support from: NOVARTIS, ABBVIE (ALWAYS AS SPEAKER), Speakers bureau: NOVARTIS, ABBVIE, Esmeralda Núñez Cuadros Grant/research support from: NOVARTIS, ABBVIE, ROCHE (ALWAYS AS SPEAKER), Speakers bureau: NOVARTIS, ABBVIE, ROCHE, Gisela Diaz-Cordobes Grant/research support from: ABBVIE, ROCHE (ALWAYS AS SPEAKER), Speakers bureau: ABBVIE, ROCHE, Laura Martín Pedraz: None declared, Antonio Urda Cardona Grant/research support from: PFIZER (ALWAYS AS SPEAKER), Speakers bureau: PFIZER