Kim S-D and Cho B-S (2006) Pamidronate therapy for preventing steroid-induced osteoporosis in children with nephropathy. Nephron Clin Pract 102: c81–c87

Corticosteroids, the first-line therapy for nephrotic syndrome in children, can cause adverse osteoporotic effects. Pamidronate, a bisphosphonate, can be used to treat such complications. A single-center prospective study in Korea has investigated whether this drug is safe and effective in children.

Following a short, intensive course of the steroid methylprednisolone, 44 children with nephropathy (including Henoch–Schönlein purpura nephritis, membranous glomerulonephritis and IgA nephropathy) were randomized 1:1 to receive oral calcium and 125 mg pamidronate or oral calcium alone. After 3 months, mean concentrations of urine pyridinoline, serum parathyroid hormone and serum osteocalcin, which are all well-known markers of OSTEOBLAST and OSTEOCLAST function, were similar in both groups. In control patients, bone mineral density—measured in the vertebrae of the lumbar spine—reduced significantly over 3 months, from 0.654 ± 0.069 g/cm2 to 0.631 ± 0.070 g/cm2 (P <0.05). In the pamidronate group, there was no significant change in bone mineral density, but five patients who had received pamidronate for longer than 5 months developed sclerotic lines at METAPHYSES. Pamidronate therapy was also associated with mild abdominal discomfort.

Preventing and treating bone loss in children with nephropathy would have a positive effect on bone strength and quality of life in adulthood. Bisphosphonates inhibit osteoclast activity and bone resorption, but the sclerotic patterns observed in the present study indicate that these drugs might also perturb skeletal growth. Pamidronate is a promising treatment for steroid-induced osteoporosis but further trials are necessary to assess its safety in the pediatric setting.