Use of Bisphosphonates in Children with Cerebral Palsy
Hurley T, Zareen Z, Stewart P, McDonnell C, McDonald D, Molloy E. The use of bisphosphonates in children with cerebral palsy. Cochrane Database of Systematic Reviews 2021, No. 7. Art. No.: CD012756. doi: 10.1002 /14651858.CD012756.pub2. Accessed August 1, 2021.
Description.
This study was designed to investigate the efficacy and safety of bisphosphonate therapy in the treatment of low BMD or secondary osteoporosis (or both) in children with cerebral palsy (GMFCS levels III to V) younger than 18 years of age.
Two related RCTs (34 participants) were included in the review, the main results of which included participants with non-ambulatory CP, CP, and osteoporosis.
Only one study (12 participants) evaluated effect measures and reported improvement in lumbar z-scores at 6 months post-intervention compared to placebo or no treatment in children treated with bisphosphonates, but with very low certainty. Only one study (12 participants) assessed effect measures and reported an improvement in lumbar z-score at 6 months post-intervention.
Secondary results reported that bisphosphonates reduced serum N-telopeptide (NTX) more than placebo, but the quality of evidence is low. Other studies reported that both bisphosphonates and alfacalcidol or alfacalcidol alone reduced NTX, but they did not compare the groups.
One study reported inconclusive results between groups for serum bone-specific alkaline phosphatase (BAP) and reported that bisphosphonates and both alfacalcidol and alfacalcidol alone lowered BAP, but did not compare groups.
Neither study reported data on the effects of bisphosphonate treatment on changes in distal radius or tibia volume BMD, fracture frequency, bone pain, or quality of life.
Authors' conclusions.
Based on the available evidence, there is very low certainty evidence that bisphosphonate therapy may improve bone health in children with cerebral palsy. We were only able to include one study with 14 participants in our effect size assessment. Thus, the precision of the effect estimate is low. Due to the lack of detail reported in the relevant studies, we were only able to evaluate one planned primary outcome.
Further research is needed from RCTs on the efficacy and safety of bisphosphonates for improving bone health in children with cerebral palsy. These studies need to identify the optimal standard of care for weight-bearing exercise, vitamin D and calcium supplementation, and should include fracture frequency as a primary outcome.
