[e-drug] Some practical questions from the field (2)

["Valeria Frighi" <Valeria.Frighi@psych.ox.ac.uk>]

E-DRUG: Some practical questions from the field (2)
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Hi Ozma,

4) Can Bisphosphonates be the drug of choice in pediatric osteoporosis?

NO, I don't think they can.

Current recommendations (from NICE, National Institute for Clinical Excellence) for bisphosphonate use in UK are not to under the age of 75 unless the patient has had a fracture.
Most endocrinologists think this is wrong to me and purely represents healthcare rationing. 

We start using them around age 60 because:
1) no long term safety data (starting in kids you'd have decades of use)
2) risk of renal complications and negative impact on bone itself after very prolonged use

TREATMENT WOULD DEPEND ON CAUSE OF OSTEOPOROSIS

A) Malnutrition of any sort: improve weight (if you can), which will also restore menses and prevent further bone loss

B) Hypogonadism with/without malnutrition: give sex hormone replacement therapy (very careful in kiddies, protocols available to avoid premature closure of epyphises and abnormal breast development)

C) Other causes: trat underlying pathology

Hope this helps,

Valeria

Dr Valeria Frighi
University Dept. of Psychiatry
Neurosciences Building
Warneford Hospital
Oxford
OX3 7JX
UK
Tel. -44 -1865 -223779
Fax -44 -1865 251076
Mobile phone 07974920013
Valeria.Frighi@psych.ox.ac.uk