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Li LJ, Zheng WB, Zhao DC, Yu W, Wang O, Jiang Y, Xia WB, Li M. Effects of zoledronic acid on vertebral shape of children and adolescents with osteogenesis imperfecta. Bone 2019; 127:164-171. [PMID: 31216496 DOI: 10.1016/j.bone.2019.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 11/17/2022]
Abstract
Vertebral compression fracture (VCF) is a common and severe complication of osteogenesis imperfecta (OI). We prospectively observe the changes of vertebral shape during zoledronic acid (ZOL) treatment and assess influence factors of VCF in OI children. 32 children with VCF and 10 children without VCF (NVCF) were included and given ZOL treatment for 2 years, who were matched in age and gender. Control group included 17 treatment naïve OI patients with VCF who were matched in age, gender and clinical severity to 17 patients in VCF group received ZOL treatment for 1 year (as ZOL treated group). We performed quantitative vertebral morphometry and calculated concavity index (mh/ph), height-length ratio (ah/LL, mh/LL, ph/LL) and projection area (PA) of vertebrae from T4 to L4 before and after treatment. At baseline, patients in VCF group had significantly lower PA, mh/ph, ah/LL, mh/LL and ph/LL than patients in NVCF group (P < 0.01). PA, mh/ph, ah/LL, mh/ LL and ph/LL of patients with VCF were raised by (35.2 ± 19.5)%, (22.9 ± 15.1)%, (19.6 ± 13.9)%, (33.6 ± 25.5)%, and (8.1 ± 8.8)% (P < 0.01) after 1-year treatment of ZOL, and were increased by (71.8 ± 28.2)%, (42.8 ± 21.8)%, (35.1 ± 20.6)%, (65.4 ± 43.2)%, and (12.5 ± 11.4)% after 2-year treatment of ZOL (P < 0.01). Compared to control group, mh/ph, ah/LL and mh/LL were significantly higher (P < 0.01) in ZOL treated group. LS-BMD and its increase were positively correlated to vertebral height and PA at baseline and the improvement of vertebral height and PA after ZOL treatment, respectively. In conclusion, the compressive vertebrae of OI children could be effectively reshaped during ZOL treatment. Low LS-BMD was an independent risk factor for VCF and its increase was positively correlated to the improvement in vertebral shape after ZOL treatment.
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Affiliation(s)
- Lu-Jiao Li
- Department of Endocrinology, National Health Commission Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Wen-Bin Zheng
- Department of Endocrinology, National Health Commission Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Di-Chen Zhao
- Department of Endocrinology, National Health Commission Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Wei Yu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ou Wang
- Department of Endocrinology, National Health Commission Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yan Jiang
- Department of Endocrinology, National Health Commission Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Wei-Bo Xia
- Department of Endocrinology, National Health Commission Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Mei Li
- Department of Endocrinology, National Health Commission Key Laboratory of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
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Zhytnik L, Maasalu K, Reimann E, Prans E, Kõks S, Märtson A. Mutational analysis of COL1A1 and COL1A2 genes among Estonian osteogenesis imperfecta patients. Hum Genomics 2017; 11:19. [PMID: 28810924 PMCID: PMC5558703 DOI: 10.1186/s40246-017-0115-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/31/2017] [Indexed: 12/15/2022] Open
Abstract
Background Osteogenesis imperfecta (OI) is a rare bone disorder. In 90% of cases, OI is caused by mutations in the COL1A1/2 genes, which code procollagen α1 and α2 chains. The main aim of the current research was to identify the mutational spectrum of COL1A1/2 genes in Estonian patients. The small population size of Estonia provides a unique chance to explore the collagen I mutational profile of 100% of OI families in the country. Methods We performed mutational analysis of peripheral blood gDNA of 30 unrelated Estonian OI patients using Sanger sequencing of COL1A1 and COL1A2 genes, including all intron-exon junctions and 5′UTR and 3′UTR regions, to identify causative OI mutations. Results We identified COL1A1/2 mutations in 86.67% of patients (26/30). 76.92% of discovered mutations were located in the COL1A1 (n = 20) and 23.08% in the COL1A2 (n = 6) gene. Half of the COL1A1/2 mutations appeared to be novel. The percentage of quantitative COL1A1/2 mutations was 69.23%. Glycine substitution with serine was the most prevalent among missense mutations. All qualitative mutations were situated in the chain domain of pro-α1/2 chains. Conclusion Our study shows that among the Estonian OI population, the range of collagen I mutations is quite high, which agrees with other described OI cohorts of Northern Europe. The Estonian OI cohort differs due to the high number of quantitative variants and simple missense variants, which are mostly Gly to Ser substitutions and do not extend the chain domain of COL1A1/2 products.
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Affiliation(s)
- Lidiia Zhytnik
- Department of Traumatology and Orthopedics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.
| | - Katre Maasalu
- Department of Traumatology and Orthopedics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.,Clinic of Traumatology and Orthopedics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia
| | - Ene Reimann
- Centre of Translational Medicine, University of Tartu, Ravila 14a, 50411, Tartu, Estonia.,Department of Pathophysiology, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - Ele Prans
- Department of Pathophysiology, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - Sulev Kõks
- Centre of Translational Medicine, University of Tartu, Ravila 14a, 50411, Tartu, Estonia.,Department of Pathophysiology, University of Tartu, Ravila 19, 50411, Tartu, Estonia
| | - Aare Märtson
- Department of Traumatology and Orthopedics, University of Tartu, Puusepa 8, 51014, Tartu, Estonia.,Clinic of Traumatology and Orthopedics, Tartu University Hospital, Puusepa 8, 51014, Tartu, Estonia
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3
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Effects of bisphosphonates on osteogenesis and osteoclastogenesis signaling during the endochondral ossification of growing rats. Cell Tissue Res 2017; 368:287-300. [DOI: 10.1007/s00441-017-2574-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 12/28/2016] [Accepted: 01/11/2017] [Indexed: 11/25/2022]
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Soares AP, do Espírito Santo RF, Line SRP, Pinto MDGF, Santos PDM, Toralles MBP, do Espírito Santo AR. Effects of Pamidronate on Dental Enamel Formation Assessed by Light Microscopy, Energy-Dispersive X-Ray Analysis, Scanning Electron Microscopy, and Microhardness Testing. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2016; 22:640-648. [PMID: 27212049 DOI: 10.1017/s1431927616000726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The aim of the present work was to investigate birefringence and morphology of the secretory-stage enamel organic extracellular matrix (EOECM), and structural and mechanical properties of mature enamel of upper incisors from adult rats that had been treated with pamidronate disodium (0.5 mg/kg/week for 56 days), using transmitted polarizing and bright-field light microscopies (TPLM and BFLM), energy-dispersive X-ray (EDX) analysis, scanning electron microscopy (SEM) and microhardness testing. BFLM showed no morphological changes of the EOECM in pamidronate and control groups, but TPLM revealed a statistically significant reduction in optical retardation values of birefringence brightness of pamidronate-treated rats when compared with control animals (p0.05). The present study indicates that pamidronate can affect birefringence of the secretory-stage EOECM, which does not seem to be associated with significant changes in morphological and/or mechanical properties of mature enamel.
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Affiliation(s)
- Ana P Soares
- 1Multidisciplinary Institute of Health,Federal University of Bahia-UFBA,Rua Rio de Contas,58,Quadra 17,Lote 58,Candeias,Vitória da Conquista,BACEP 45.029-094,Brasil
| | - Renan F do Espírito Santo
- 2Faculty of Pharmacy,Federal University of Bahia-UFBA,Rua Barão de Jeremoabo,S/N,Campus Universitário de Ondina,Ondina,Salvador,BA CEP 40.170-115,Brasil
| | - Sérgio R P Line
- 3Piracicaba Dental School,University of Campinas-UNICAMP,Av. Limeira,901,Areião,Piracicaba,SP CEP 13.414-903,Brasil
| | - Maria das G F Pinto
- 4School of Veterinary Medicine and Zootechny,Federal University of Bahia-UFBA,Av. Ademar de Barros,500,Ondina,Salvador,BA CEP 40.170-110,Brasil
| | - Pablo de M Santos
- 5Professor Edgard Santos University Hospital,Federal University of Bahia-UFBA,Rua Augusto Viana,S/N,Canela,Salvador,BA CEP 40.110-060,Brasil
| | - Maria Betania P Toralles
- 6Institute of Health Sciences,Federal University of Bahia-UFBA,Av. Reitor Miguel Calmon,S/N,Vale do Canela,Salvador,BA CEP 40.110-902,Brasil
| | - Alexandre R do Espírito Santo
- 6Institute of Health Sciences,Federal University of Bahia-UFBA,Av. Reitor Miguel Calmon,S/N,Vale do Canela,Salvador,BA CEP 40.110-902,Brasil
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Soares AP, do Espírito Santo RF, Line SRP, Pinto MDGF, Santos PDM, Toralles MBP, do Espírito Santo AR. Bisphosphonates: Pharmacokinetics, bioavailability, mechanisms of action, clinical applications in children, and effects on tooth development. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2016; 42:212-217. [PMID: 26895384 DOI: 10.1016/j.etap.2016.01.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 01/18/2016] [Accepted: 01/20/2016] [Indexed: 06/05/2023]
Abstract
Bisphosphonates (BPs) avidly bind to calcium crystals and inhibit osteoclastic bone resorption, making them useful for treatment of skeletal disorders such as osteoporosis, Paget's disease, osteogenesis imperfecta and metastatic bone diseases. BPs therapeutically act by causing toxic effects on osteoclasts or interfering with specific intracellular pathways in those cells. BPs that possess nitrogen in their composition are called nitrogen-containing BPs (NBPs) and include alendronate, pamidronate, risedronate, ibandronate, and zoledronate. Simple BPs or non-NBPs do not have nitrogen in their composition, include etiodronate and clodronate, and were the first to be tested in animals and clinically used. Because BPs may be administered to pregnant women or children during deciduous and permanent teeth development, it is expected that they might disturb tooth eruption and development. A review of current literature on pharmacokinetics, bioavailability, mechanisms of action, and clinical applications of BPs in children, and their effects on tooth eruption and development is presented.
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Affiliation(s)
- Ana Prates Soares
- Multidisciplinary Institute of Health, Federal University of Bahia - UFBA, Rua Rio de Contas, 58, Quadra 17, Lote 58, Candeias, Vitória da Conquista, BA CEP 45.029-094, Brazil.
| | - Renan Fernandes do Espírito Santo
- Faculty of Pharmacy, Federal University of Bahia - UFBA, Rua Barão de Jeremoabo, S/N, Campus Universitário de Ondina, Ondina, Salvador, BA CEP 40.170-115, Brazil.
| | - Sérgio Roberto Peres Line
- Piracicaba Dental School, University of Campinas - UNICAMP, Av. Limeira, 901, Areião, Piracicaba, SP CEP 13.414-903, Brazil.
| | - Maria das Graças Farias Pinto
- School of Veterinary Medicine and Zootechny, Federal University of Bahia - UFBA, Av. Ademar de Barros, 500, Ondina, Salvador, BA CEP 40.170-110, Brazil.
| | - Pablo de Moura Santos
- Professor Edgard Santos University Hospital, Federal University of Bahia - UFBA, Rua Augusto Viana, S/N, Canela, Salvador, BA CEP 40.110-060, Brazil.
| | - Maria Betânia Pereira Toralles
- Institute of Health Sciences, Federal University of Bahia - UFBA, Av. Reitor Miguel Calmon, S/N, Vale do Canela, Salvador, BA CEP 40.110-902, Brazil.
| | - Alexandre Ribeiro do Espírito Santo
- Institute of Health Sciences, Federal University of Bahia - UFBA, Av. Reitor Miguel Calmon, S/N, Vale do Canela, Salvador, BA CEP 40.110-902, Brazil.
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Bradaschia-Correa V, Casado-Gomez I, Moreira MM, Ferreira LB, Arana-Chavez VE. Immunolocalization of Smad-4 in developing molar roots of alendronate-treated rats. Arch Oral Biol 2013; 58:1744-50. [DOI: 10.1016/j.archoralbio.2013.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 05/04/2013] [Accepted: 06/05/2013] [Indexed: 01/29/2023]
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Shah I, Johari A. Oral bisphosphonate treatment for osteogenesis imperfecta—an Indian perspective. ACTA ACUST UNITED AC 2013; 27:39-43. [PMID: 17469731 DOI: 10.1179/146532807x170493] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Various treatments for the management of osteogenesis imperfecta (OI) have been tried, of which bisphosphonates seem to have the maximum benefit in reducing fracture rate and improving bone density. This study investigated the value of oral alendronate for treating OI in Indian children. METHODS Between 2002 and 2005, 11 patients with OI were referred for bisphosphonate therapy. The various types of OI were classified using the Sillence criteria. All patients underwent baseline biochemistry, radiographic studies and bone mineral density (BMD) measurements before commencing therapy. Patients were commenced on oral alendronate (0.5 mg/kg/day) and followed up for a period ranging from 1 month to 2 years. A retrospective analysis of pre- and post-treatment changes in fracture rate and bone density was undertaken using the paired sample t-test. RESULTS One patient lost to follow-up was excluded from the study and three completed only 2 months of therapy. Pre-treatment fracture rate per year before treatment ranged from 0.5 to 6 with a mean (SD) of 2.95 (1.57) and median of 2.5. The post-treatment fracture rate was 1.1 (0.59)/year (p=0.02). Seven children underwent BMD analysis while on treatment and all had a rise in BMD, of which the change in lumbar spine BMD was statistically significant (p=0.001), and lumbar (p=0.005) and femoral neck t-score (p=0.04) showed a significant change. No significant change was seen in serum biochemistry except for disappearance ofhypercalciuria (p=0.04). No child had an adverse reaction to alendronate. CONCLUSION After a median of 9.5 months of treatment, oral alendronate is associated with a lower fracture rate, improvement in BMD and a decrease in hypercalciuria.
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Affiliation(s)
- Ira Shah
- Departments of Pediatrics, B. J. Wadia Hospital for Children, Mumbai, India.
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8
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Reduced RANKL expression impedes osteoclast activation and tooth eruption in alendronate-treated rats. Cell Tissue Res 2013; 353:79-86. [PMID: 23636419 DOI: 10.1007/s00441-013-1623-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 04/01/2013] [Indexed: 10/26/2022]
Abstract
The creation of the eruption pathway requires the resorption of the occlusal alveolar bone by osteoclasts and signaling events between bone and dental follicle are necessary. The aim of the present study has been to evaluate the effect of alendronate on osteoclastogenesis and the expression of the regulator proteins of osteoclast activation, namely RANK, RANKL and OPG, in the bone that covers the first molar germ. Newborn Wistar rats were treated daily with 2.5 mg/kg alendronate for 4, 8, 14, 21 and 28 days, whereas controls received sterile saline solution. At the time points cited, maxillae were fixed, decalcified and processed for light and electron microscopic analysis. TRAP histochemistry was performed on semi-serial sections and the osteoclasts in the occlusal half of the bony crypt surface were counted. TUNEL analysis was carried out on paraffin sections. The occlusal bone that covers the upper first molar was removed in additional 4- and 8-day-old alendronate-treated and control rats in which the expression of RANK, RANKL and OPG was analyzed by SDS-polyacrylamide gel electrophoresis and Western blotting. TRAP-positive osteoclasts were more numerous in the alendronate group at all time points, despite their unactivated phenotype and the presence of apoptotic cells. RANKL expression in the alendronate specimens was inhibited at all time points, unlike in controls. Our findings indicate that the expression of RANKL in the occlusal portion of the bony crypt is unrelated to osteoclast recruitment and differentiation but is crucial to their activation during the creation of the eruption pathway.
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Bradaschia-Correa V, Barrence FAC, Ferreira LB, Massa LF, Arana-Chavez VE. Effect of alendronate on endochondral ossification in mandibular condyles of growing rats. Eur J Histochem 2012; 56:e24. [PMID: 22688305 DOI: 10.4081/ejh.2012.24] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 02/23/2012] [Accepted: 03/13/2012] [Indexed: 11/22/2022] Open
Abstract
The replacement of the calcified cartilage by bone tissue during the endochondral ossification of the mandibular condyle is dependent of the resorbing activity of osteoclats. After partial resorption, calcified cartilage septa are covered by a primary bone matrix secreted by osteoblasts. Osteoadherin (OSAD) is a small proteoglycan present in bone matrix but absent in cartilage during the endochondral ossification. The aim of this study was to analyze the effect of alendronate, a drug known to inhibit bone resorption by osteoclasts, on the endochondral ossification of the mandibular condyle of young rats, by evaluating the distribution of osteoclasts and the presence of OSAD in the bone matrix deposited. Wistar newborn rats (n=45) received daily injections of alendronate (n=27) or sterile saline solution as control (n=18) from the day of birth until the ages of 4, 14 and 30 days. At the days mentioned, the mandibular condyles were collected and processed for transmission electron microscopy analysis. Specimens were also submitted to tartrate resistant acid phosphatase (TRAP) histochemistry and ultrastructural immunodetection of OSAD. Alendronate treatment did not impede the recruitment and fusion of osteoclasts at the ossification zone during condyle growth, but they presented inactivated phenotype. The trabeculae at the ossification area consisted of cartilage matrix covered by a layer of primary bone matrix that was immunopositive to OSAD at all time points studied. Apparently, alendronate impeded the removal of calcified cartilage and maturation of bone trabeculae in the mandibular ramus, while in controls they occurred normally. These findings highlight for giving attention to the potential side-effects of bisphosphonates administered to young patients once it may represent a risk of disturbing maxillofacial development.
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Affiliation(s)
- V Bradaschia-Correa
- Division of Oral Biology, School of Dentistry, University of São Paulo, Brazil
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10
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Nakhla M, Denker AE, Connor JD, Carpenter TO, Walson PD, Porras AG, Matthews CZ, Larson P, Freeman A, Wagner JA, Ward LM. Bioavailability and short-term tolerability of alendronate in glucocorticoid-treated children. Clin Ther 2011; 33:1516-23. [PMID: 21962451 DOI: 10.1016/j.clinthera.2011.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Children receiving glucocorticoids (GCs) are at an increased risk of fragility fractures. Conservative measures may be inadequate in treating low bone mass, giving rise to fractures in this population; as such, attention has turned to the use of bisphosphonates. OBJECTIVE The goal of this study was to evaluate the bioavailability and single-dose tolerability of alendronate (ALN) in children receiving a stable dose of GCs. METHODS Children (ages 4-17 years) receiving GC treatment for their chronic illnesses received intravenous (125 μg) and oral (35 mg) ALN in a 2-period, randomized crossover study, with doses separated by at least a 7-day washout period. Urine was collected for either 8 or 24 hours after drug administration to determine urinary excretion of ALN and bioavailability. Tolerability was assessed by continuous collection of adverse events reported during the study. The main outcome measures were total urinary excretion rates, oral bioavailability of ALN, and adverse events. RESULTS There were 12 patients in the 4- to 11-year-old group (mean age, 8.1 years; 5 girls) and 12 patients in the 12- to 17-year-old group (mean age, 14.3 years; 5 girls). The least-squares mean bioavailability (90% CI) for children aged 4 to 11 years (n = 12) was 0.43% (0.27-0.67) and for children aged 12 to 17 years (n = 12) it was 0.39% (0.26-0.60). The least-squares mean bioavailability for all ages combined was 0.41% (0.30-0.56), with no statistical difference between the 2 age groups. The total urinary excretion of ALN after the intravenous dose was similar between groups. Fifteen patients reported a total of 36 transient clinical nonserious adverse events, all of which were mild or moderate in intensity; the most common were headache (n = 13), abdominal pain (n = 3), limb, neck, or facial pain (n = 6), and ankle or knee swelling (n = 3). CONCLUSIONS The mean oral bioavailability of ALN was similar to previous pharmacokinetic studies in children with osteogenesis imperfecta and slightly lower than that observed in historical adult controls. Alendronate was generally well tolerated, with minor adverse events that resolved uneventfully. Elucidation of the full adverse-effect profile of this agent was limited by the single-dose nature of this study, and robust comparisons of the pharmacokinetics of ALN in different age groups may need a larger number of patients.
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Affiliation(s)
- Meranda Nakhla
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
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Ward LM, Rauch F, Whyte MP, D'Astous J, Gates PE, Grogan D, Lester EL, McCall RE, Pressly TA, Sanders JO, Smith PA, Steiner RD, Sullivan E, Tyerman G, Smith-Wright DL, Verbruggen N, Heyden N, Lombardi A, Glorieux FH. Alendronate for the treatment of pediatric osteogenesis imperfecta: a randomized placebo-controlled study. J Clin Endocrinol Metab 2011; 96:355-64. [PMID: 21106710 DOI: 10.1210/jc.2010-0636] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
CONTEXT Information on the use of oral bisphosphonate agents to treat pediatric osteogenesis imperfecta (OI) is limited. OBJECTIVE The objective of the investigation was to study the efficacy and safety of daily oral alendronate (ALN) in children with OI. DESIGN AND PARTICIPANTS We conducted a multicenter, double-blind, randomized, placebo-controlled study. One hundred thirty-nine children (aged 4-19 yr) with type I, III, or IV OI were randomized to either placebo (n = 30) or ALN (n = 109) for 2 yr. ALN doses were 5 mg/d in children less than 40 kg and 10 mg/d for those 40 kg and greater. MAIN OUTCOME MEASURES Spine areal bone mineral density (BMD) z-score, urinary N-telopeptide of collagen type I, extremity fracture incidence, vertebral area, iliac cortical width, bone pain, physical activity, and safety parameters were measured. RESULTS ALN increased spine areal BMD by 51% vs. a 12% increase with placebo (P < 0.001); the mean spine areal BMD z-score increased significantly from -4.6 to -3.3 (P < 0.001) with ALN, whereas the change in the placebo group (from -4.6 to -4.5) was insignificant. Urinary N-telopeptide of collagen type I decreased by 62% in the ALN-treated group, compared with 32% with placebo (P < 0.001). Long-bone fracture incidence, average midline vertebral height, iliac cortical width, bone pain, and physical activity were similar between groups. The incidences of clinical and laboratory adverse experiences were also similar between the treatment and placebo groups. CONCLUSIONS Oral ALN for 2 yr in pediatric patients with OI significantly decreased bone turnover and increased spine areal BMD but was not associated with improved fracture outcomes.
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Affiliation(s)
- L M Ward
- Genetics Unit, Shriners Hospital for Children, 1529 Cedar Avenue, Montréal, Québec, Canada
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Monti E, Mottes M, Fraschini P, Brunelli P, Forlino A, Venturi G, Doro F, Perlini S, Cavarzere P, Antoniazzi F. Current and emerging treatments for the management of osteogenesis imperfecta. Ther Clin Risk Manag 2010; 6:367-81. [PMID: 20856683 PMCID: PMC2940745 DOI: 10.2147/tcrm.s5932] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Indexed: 11/23/2022] Open
Abstract
Osteogenesis imperfecta (OI) is the most common bone genetic disorder and it is characterized by bone brittleness and various degrees of growth disorder. Clinical severity varies widely; nowadays eight types are distinguished and two new forms have been recently described although not yet classified. The approach to such a variable and heterogeneous disease should be global and therefore multidisciplinary. For simplicity, the objectives of treatment can be reduced to three typical situations: the lethal perinatal form (type II), in which the problem is survival at birth; the severe and moderate forms (types III-IX), in which the objective is 'autonomy'; and the mild form (type I), in which the aim is to reach 'normal life'. Three types of treatment are available: non-surgical management (physical therapy, rehabilitation, bracing and splinting), surgical management (intramedullary rod positioning, spinal and basilar impression surgery) and medical-pharmacological management (drugs to increase the strength of bone and decrease the number of fractures as bisphosphonates or growth hormone, depending on the type of OI). Suggestions and guidelines for a therapeutic approach are indicated and updated with the most recent findings in OI diagnosis and treatment.
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Affiliation(s)
- Elena Monti
- Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy
| | - Monica Mottes
- Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy
| | - Paolo Fraschini
- Istituto Di Ricovero e Cura a Carattere Scientifico, ‘E. Medea’, Associazione La Nostra Famiglia, Bosisio Parini (LC), Italy
| | | | - Antonella Forlino
- Department of Biochemistry “A. Castellani”, University of Pavia, Italy
| | - Giacomo Venturi
- Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy
| | - Francesco Doro
- Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy
| | - Silvia Perlini
- Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy
| | - Paolo Cavarzere
- Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy
| | - Franco Antoniazzi
- Department of Life Sciences and Reproduction, Pediatric Clinic University of Verona, Verona, Italy
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do Espírito Santo AR, Frozoni MRS, Ramos-Perez FMM, Novaes PD, Line SRP. Birefringence of the secretory-stage enamel organic extracellular matrix from rats submitted to successive injections of bisphosphonates. Connect Tissue Res 2010; 51:208-15. [PMID: 20109069 DOI: 10.3109/03008200903280115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of the present study was to assess birefringence of the secretory-stage enamel organic extracellular matrix (ECM) and mechanical properties of mature enamel from rats treated with bisphosphonates. Longitudinal sections were obtained from upper incisors of rats that had been submitted to injections of bisodic etidronate (8 mg/Kg/day), sodium alendronate (30 microg/Kg/day), or sodium chloride as control (8 mg/Kg/day) for 42 days. Sections were immersed in 80% glycerin for 30 min and optical retardation of birefringence brightness in the secretory-stage enamel organic ECM was determined in nanometers. Etidronate-treated rats exhibited extensive morphological changes in the secretory-stage enamel organic ECM inclusive nonbirefringent conspicuous incremental lines, but presented optical retardation values similar to those showed by control rats (p > 0.05). Birefringence of secretory enamel organic ECM from etidronate rats presented an irregular aspect. Alendronate-treated rats did not show morphological alterations in the secretory-stage enamel organic ECM, however, they presented significant reduction in optical retardation of birefringence brightness when compared with control and etidronate rats (p < 0.01). Alendronate and etidronate groups exhibited reductions of approximately 6-10% in mature enamel cross-sectional microhardness when compared with control group (p < 0.01). Scanning electron microscopy analysis showed extensive alterations in mature enamel only from etidronate group with absence of enamel rods. The present work shows that bisphosphonates can affect the birefringence of the secretory-stage enamel organic ECM. The results presented here suggest that alterations in the supramolecular organization of the secretory-stage enamel organic ECM are a plausible mechanism by which environmental factors may cause enamel defects.
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Ward LM, Petryk A, Gordon CM. Use of bisphosphonates in the treatment of pediatric osteoporosis. ACTA ACUST UNITED AC 2009. [DOI: 10.2217/ijr.09.58] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Affiliation(s)
- Asaf Bitton
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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16
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Castillo H, Samson-Fang L. Effects of bisphosphonates in children with osteogenesis imperfecta: an AACPDM systematic review. Dev Med Child Neurol 2009; 51:17-29. [PMID: 19087101 DOI: 10.1111/j.1469-8749.2008.03222.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This systematic review of the effects of bisphosphonate treatment in children with osteogenesis imperfecta was conducted using the American Academy for Cerebral Palsy and Developmental Medicine methodology for developing systematic reviews of treatment interventions (Revision 1.1) 2004. Despite a large body of published literature, there have been only eight studies with a sufficiently high level of internal validity to be truly informative. These studies confirm improvement in bone density. Many, but not all studies, demonstrate reduction in fracture rate and enhanced growth. There has been extremely limited evaluation of broader treatment impacts such as deformity, need for orthopedic surgery, pain, functioning, or quality of life. Short-term side effects were minimal. Which medication and dosing regimen is optimal and how long patients should be treated are unclear. This body of evidence would be strengthened by a larger controlled trial, because many studies lacked adequate power to evaluate stated outcomes. These studies do not address the impacts of bisphosphonates in children with milder forms of osteogenesis imperfecta and severe forms that are not due to mutations in the type I pro-collagen gene (e.g. types VII and VIII). Additional research is needed into treatment of infants. More studies evaluating medication choices, optimal dosing, duration of treatment, post-treatment impacts, and long-term side effects are necessary.
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Affiliation(s)
- Heidi Castillo
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Brown JJ, Zacharin MR. Safety and efficacy of intravenous zoledronic acid in paediatric osteoporosis. J Pediatr Endocrinol Metab 2009; 22:55-63. [PMID: 19344075 DOI: 10.1515/jpem.2009.22.1.55] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To study the safety and efficacy of zoledronic acid treatment in children with osteoporotic bone disorders. STUDY DESIGN Observational study in 22 patients with osteogenesis imperfecta and related conditions who were treated at our institution with zoledronic acid. These patients had initial treatment with pamidronate. Lumbar spine z-scores, annual change in areal bone mineral density, bone mineral adjusted density, fracture number and linear growth before and after zoledronic acid treatment was commenced were compared. RESULTS Patients were treated for a mean of 3.4 years with zoledronic acid after a mean of 3.75 years of pamidronate therapy. There was no difference in areal bone mineral density accrual in the first year of zoledronic acid treatment compared to the preceding year of pamidronate treatment. Lumbar spine z-scores and bone mineral adjusted density continued to increase with zoledronic acid. Number of fractures during treatment was significantly reduced compared to baseline with either bisphosphonate, with no difference between treatments. Linear growth was not affected. CONCLUSIONS Zoledronic acid is at least as effective as pamidronate as treatment for paediatric osteoporosis, and has a similar safety profile.
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Affiliation(s)
- J J Brown
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Australia.
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Abstract
Osteogenesis Imperfecta is a heritable disorder characterized by bone fragility and low bone mass, with a wide spectrum of clinical expression. This review gives an update on its classification, the recent developments in the understanding of its pathophysiological mechanisms, and the current status of bisphosphonate therapy. Other therapeutic approaches and future directions of research are briefly discussed.
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Affiliation(s)
- Francis H Glorieux
- Genetics Unit, Shriners Hospital for Children, 1529 Cedar Avenue, McGill University, Montréal, Québec, Canada H3G 1A6.
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19
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Glorieux FH. Treatment of osteogenesis imperfecta: who, why, what? HORMONE RESEARCH 2007; 68 Suppl 5:8-11. [PMID: 18174695 DOI: 10.1159/000110463] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Osteogenesis imperfecta (OI) is a heritable disorder characterized by bone fragility and reduced bone mass. It may present with a wide range of severity. About 85% of the cases are linked to mutations in one of the two genes encoding type I collagen. In other cases of OI, there are mutations in the expression of a cartilage-related protein or of 3-prolyl-hydroxylase. Increased bone turnover rate, due to the repair activity triggered to replace weak tissue, is the rule. Often, disuse bone loss further compounds the decrease in bone mass. These findings justify the use of bisphosphonates to reduce osteoclast-mediated bone resorption, and so tilt the remodeling balance towards an increase in bone mass. CONCLUSIONS Cyclical intravenous pamidronate administration reduces bone pain, and increases bone mass and density. No negative effects on growth or fracture repair have been observed. There is an increase in size of vertebral bodies and thickening of cortical bone, which translates into decreased fracture incidence and improved ambulation. However, the long-term consequences of low bone turnover in children with OI are unknown at the present time. Innovative surgery and specific occupational and physiotherapy programs are integral parts of the treatment protocol. This approach will prevail until gene-based therapies become clinically applicable.
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Affiliation(s)
- Francis H Glorieux
- Department of Surgery, Pediatrics and Human Genetics, Shriner's Hospital, McGill University, Montréal, Qué., Canada.
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Bradaschia-Correa V, Massa LF, Arana-Chavez VE. Effects of alendronate on tooth eruption and molar root formation in young growing rats. Cell Tissue Res 2007; 330:475-85. [PMID: 17901984 DOI: 10.1007/s00441-007-0499-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Accepted: 08/28/2007] [Indexed: 10/22/2022]
Abstract
Tooth eruption consists of the movement of teeth from the bony crypt in which they initiate their development to the occlusal plane in the oral cavity. Interactions between the tooth germ and its surrounding alveolar bone occur in order to offer spatial conditions for its development and eruption. This involves bone remodeling during which resorption is a key event. Bisphosphonates are a group of drugs that interfere with the resorption of mineralized tissues. With the purpose of investigating the effects of sodium alendronate (a potent bisphosphonate inhibitor of osteoclast activity) on alveolar bone during tooth development and eruption, we gave newborn rats daily doses of this drug for 4, 14, and 30 days. Samples of the maxillary alveolar process containing the tooth germs were processed for light, transmission, and scanning electron microscopy and were also submitted to tartrate-resistant acid phosphatase histochemistry and high-resolution colloidal-gold immunolabeling for osteopontin. Inhibition of osteoclast activity by sodium alendronate caused the absence of tooth eruption. The lack of alveolar bone remodeling resulted in primary bone with the presence of latent osteoclasts and abundant osteopontin at the interfibrillar regions. The developing bone trabeculae invaded the dental follicle and reached the molar tooth germs, provoking deformities in enamel surfaces. No root formation was observed. These findings suggested that alendronate effectively inhibited tooth eruption by interfering with the activation of osteoclasts, which remained in a latent stage.
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Affiliation(s)
- Vivian Bradaschia-Correa
- Laboratory of Mineralized Tissue Biology, Department of Cell and Developmental Biology, Institute of Biomedical Sciences, University of São Paulo, 05508-900 São Paulo, Brazil
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Abstract
Until recently, medical management of osteogenesis imperfecta, a genetic disorder of reduced bone mass and frequent fractures, was elusive, and treatment was focused on maximizing mobility and function. The introduction of bisphosphonates for the treatment of osteogenesis imperfecta 14 years ago changed this paradigm. Cyclic intravenous pamidronate therapy leads to an increase in bone density and a decrease in fracture rate in patients with osteogenesis imperfecta. Pamidronate therapy has a positive impact on functional parameters including improved energy, decreased bone pain, and increased ambulation. Histomorphometric studies have shown that the reduced osteoclast activity results in gains in cortical thickness and trabecular bone volume. Potential negative effects may include prolonged time to heal after osteotomies and a decrease in the rate of bone remodeling. Overall, it seems clear that the benefits of pamidronate therapy outweigh its potential risks in moderate-to-severe osteogenesis imperfecta, and pamidronate therapy has become the standard of care for patients with this condition. Questions remain regarding when treatment should be stopped and the need for pamidronate therapy in patients with mild osteogenesis imperfecta.
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Affiliation(s)
- Francis H Glorieux
- Genetics Unit, Shriners Hospital for Children and McGill University, Montreal, Quebec, Canada.
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Abstract
AIMS Osteogenesis imperfecta (OI) is a chronic, disabling condition characterized by bone fragility resulting from defective production of type I collagen. Pamidronate therapy is the most extensively studied treatment and has proved beneficial. Our objective was to evaluate the effect of alendronate, a more potent bisphosphonate than pamidronate, in OI. MATERIALS AND METHODS Three patients (age, 3-7 years; mean, 5 years) (one case, type III; 2 cases, type IV) have been given alendronate (0.3-0.56 mg/kg per day orally) for 2 years. Number of fractures, ambulation, height growth, and bone mineral density by dual-energy x-ray absorptiometry (DXA) were followed up. RESULTS Bone mineral density improved significantly after the 2-year alendronate treatment, which increased by 47.8% to 106.6% in the lumbar spine and by 24% to 51.4% in forearm bones. The z-score of lumbar spine DXA values increased from -5.26 +/- 0.84 to -3.1 +/- 0.59. The mean of fracture rates did not change significantly. Only one of the patients was highly limited in ambulation. She had curved legs and could not sit without support before the treatment. She improved to walk with help by the treatment. Serum parathormone and alkaline phosphatase concentrations did not change significantly. No side effect was detected in clinical and laboratory evaluations. CONCLUSION The study suggests that alendronate is a safe and well-tolerated drug and that it could increase bone density in children with OI, all of which encourage further studies with the bisphosphonates that are more potent than pamidronate and can be used orally. In addition, this study is the first report using the forearm bone mineral density measurement in OI.
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Affiliation(s)
- Ercan Madenci
- Departments of Physical Therapy and Rehabilitation, Gaziantep University, Medical Faculty, 27100 Gaziantep, Turkey.
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Thornton J, Ashcroft DM, Mughal MZ, Elliott RA, O'Neill TW, Symmons D. Systematic review of effectiveness of bisphosphonates in treatment of low bone mineral density and fragility fractures in juvenile idiopathic arthritis. Arch Dis Child 2006; 91:753-61. [PMID: 16690698 PMCID: PMC2082926 DOI: 10.1136/adc.2006.093997] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2006] [Indexed: 11/04/2022]
Abstract
AIMS To evaluate the currently available evidence for the effectiveness of bisphosphonates in children with low bone mineral density (BMD) and fragility fractures associated with juvenile idiopathic arthritis (JIA), and the safety of bisphosphonates in JIA and other conditions. METHODS Literature databases were searched using a structured search strategy. The effectiveness review included any studies of children with JIA treated with bisphosphonates. The safety review also included studies of osteogenesis imperfecta. Quantitative data analysis was not undertaken because of the heterogeneity of the studies; findings were summarised using tables and narrative synthesis. RESULTS Ninety four studies were identified. Sixteen studies (78 JIA children) were included in the effectiveness review: one randomised controlled trial, three controlled cohort studies, 11 case series, and one case report. At baseline, children had low BMD below the expected values for age and sex matched children. In all studies, treatment with bisphosphonates increased BMD compared with baseline: the mean percentage increase in spine BMD ranged from 4.5% to 19.1%. Overall, studies were heterogeneous and of variable quality. A total of 59 papers were included in the safety review; treatment durations were up to three years. The most common side effect was a flu-like reaction with intravenous treatment. This occurred during the first infusion and was transient; the symptoms were managed with paracetamol and did not occur during subsequent cycles. CONCLUSIONS Bisphosphonates are a promising treatment for low BMD and fragility fractures in children with JIA. However, the quality of the current evidence is variable and better studies are needed to more clearly assess their role.
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Affiliation(s)
- J Thornton
- Arthritis Research Campaign Epidemiology Unit, Division of Epidemiology and Health Sciences, University of Manchester, UK
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Spadaro JA, Damron TA, Horton JA, Margulies BS, Murray GM, Clemente DA, Strauss JA. Density and structural changes in the bone of growing rats after weekly alendronate administration with and without a methotrexate challenge. J Orthop Res 2006; 24:936-44. [PMID: 16609966 DOI: 10.1002/jor.20145] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Alendronate (ALN) and other bisphosphonates have been used successfully in pediatric patients with osteopenia secondary to connective tissue diseases. Loss of growth in height has not been reported, but concerns remain regarding the effect of these potent antiresorptive agents when used in children and adolescents. High-dose methotrexate (MTX) and other chemotherapy drugs have been implicated in osteoporosis and a high fracture incidence in survivors of childhood cancers and are also associated with osteopenia in adult animals. The effect of high dose MTX on bone density during rapid skeletal growth, however, has not been widely studied, nor has the potentially therapeutic effect of bisphosphonates in this setting. We examined the effects of ALN and MTX administration, alone and in combination, on bone density, morphology, mechanical strength, and longitudinal growth in normal growing rats. Sprague-Dawley rats were given ALN once weekly (0.3 mg/kg) from 5 to 11 weeks of age, with and without a course of methotrexate (MTX) given daily in weeks 1 and 3 (0.75 mg/kg/day). Twenty-four animals were randomly divided into four groups: Control (vehicle), ALN alone, ALN + MTX, and MTX alone. After 6 weeks, the femora, tibiae, and lumbar spine were studied by dual-energy X-ray absorptiometry, peripheral quantitative computed tomography, mechanical strength testing, microradiography, light microscopy, and by determination of ash weights and bone lengths. ALN treatment increased bone mineral density (BMD) by 23% to 68%. The largest increases in the femur occurred in the distal third where endochondral bone growth was greatest and included large increases in trabecular bone and total cross-sectional area. ALN + MTX produced similar effects to ALN alone. MTX only reduced BMD by 8% in the vertebrae, but not significantly at other sites. MTX also led to femoral length reductions of 2.9%. The small reductions in BMD due to MTX were overwhelmed by the increases due to ALN, whereas the length loss was unaffected. Transverse density banding corresponding to weekly ALN administrations were clearly evident radiographically throughout the growing skeleton, likely due to decreased resorption and possibly increased mineralization in the bands. ALN or ALN + MTX treatment also led to increases in mechanical strength in the femora. Although MTX administration during growth leads to some BMD reduction, ALN given with MTX eliminates this reduction and in fact bone density and strength increase above control levels.
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Affiliation(s)
- J A Spadaro
- Department of Orthopedic Surgery, Musculoskeletal Science Research Center, Room 3119, Institute for Human Performance, 505 Irving Avenue, Syracuse, New York 13210, USA.
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26
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Abstract
Osteoporosis is increasingly being seen in young people. The primitive forms are relatively rare, but the secondary forms--particularly in long-term corticosteroid therapy--are a relevant problem given the much longer survival in chronic diseases such as cystic fibrosis, chronic renal insufficiency, leukaemia, and Duchenne muscular dystrophy. Controlled, prospective studies to evaluate the results of prevention and therapy in children are still lacking. The basis of therapy is the correct daily intake of calcium and the use of vitamin D (or active metabolites). This helps the growing skeleton to restore its equilibrium in many cases. Restraining the long-term use of corticosteroids to the minimum effective dose and shorter duration is essential. In severe cases, particularly in the presence of fractures, bisphosphonates can be remarkably effective. In some cases, such as idiopathic juvenile osteoporosis, the rule is spontaneous resolution, and the advisability of an aggressive drug therapy is discussed.
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Affiliation(s)
- Maria Luisa Bianchi
- Bone Metabolism Unit, Istituto Auxologico Italiano, IRCCS, Via L. Ariosto, 13, Milano, Italy.
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Massa LF, Bradaschia-Correa V, Arana-Chavez VE. Immunocytochemical Study of Amelogenin Deposition during the Early Odontogenesis of Molars in Alendronate-treated Newborn Rats. J Histochem Cytochem 2006; 54:713-25. [PMID: 16461365 DOI: 10.1369/jhc.5a6853.2006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Newborn rats were treated with sodium alendronate to study how enamel is formed and the effect of alendronate during early odontogenesis. Ultrastructural analysis combined with high-resolution immunocytochemistry for amelogenin was carried out. Twelve rats were subjected to daily SC injections of sodium alendronate (2.5 mg/kg/day) for 3 days on their dorsal region, whereas three rats were daily injected with saline solution as a control. Molar tooth germs from 3-day-old rats were fixed under microwave irradiation in 0.1% glutaraldehyde + 4% formaldehyde buffered at pH 7.2 with 0.1 M sodium cacodylate. The specimens were left undecalcified, postfixed with osmium tetroxide, dehydrated, and embedded in LR White resin. Ultrathin sections were incubated with a chicken anti-24-kDa rat amelogenin antibody, a secondary antibody, and finally with a protein A-gold complex. Large patches of amelogenin were present over the unmineralized mantle dentin and at early secretory ameloblasts. At more advanced stages, they were also detected at the enamel matrix, as well as in the mineralized dentin, at the periodontoblastic space of the dentinal tubules, and at the predentin. It is likely that the main effect of alendronate at early stages of odontogenesis is the increase of synthesis/secretion of amelogenin, promoting its deposition within the forming dentin and enamel.
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Affiliation(s)
- Luciana F Massa
- Laboratory of Mineralized Tissue Biology, Department of Cell and Developmental Biology, Institute of Biomedical Sciences, University of São Paulo, 05508-900 São Paulo, SP, Brazil
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John BM, Patnaik SK, Thergaonkar RW. Multiple Fractures in Neonates and Osteogenesis Imperfecta. Med J Armed Forces India 2006; 62:73-4. [PMID: 27407852 PMCID: PMC4923375 DOI: 10.1016/s0377-1237(06)80165-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2004] [Accepted: 01/04/2005] [Indexed: 11/30/2022] Open
Affiliation(s)
- B M John
- Graded Specialist (Paediatrics), 7 Air Force Hospital, Kanpur
| | - S K Patnaik
- Graded Specialist (Paediatrics), 7 Air Force Hospital, Kanpur
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Vyskocil V, Pikner R, Kutílek S. Effect of alendronate therapy in children with osteogenesis imperfecta. Joint Bone Spine 2005; 72:416-23. [PMID: 16214075 DOI: 10.1016/j.jbspin.2004.09.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2004] [Accepted: 09/10/2004] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the effect of orally administered alendronate in children with osteogenesis imperfecta. METHODS Thirty children (16 girls and 14 boys; mean age at baseline 10.7 +/- 6.0 years; range 4-16 years) with osteogenesis imperfecta type I (n = 22), III (n = 2), or IV (n = 6) were treated with alendronate (5 mg/day in patients aged 4-10 years and 10 mg/day in children >10 years of age) for 3 years. RESULTS After 1 year of alendronate therapy we observed a significant increase in areal and volumetric bone mineral density Z-scores (from -2.03 +/- 1.51 to -1.04 +/- 1.20, and from -1.91 +/- 1.38 to -1.33 +/- 1.30, respectively, P < 0.001), together with a significant drop in fracture rate (from 3.77 +/- 1.57 to 0.13 +/- 0.57, P < 0.000001), relief of chronic pain (from 3.83 +/- 1.44 days of pain/week to 0.73 +/- 0.77, P < 0.000001) and improvement in ambulation/mobility (P < 0.00002). After additional 2 years of therapy there were no further significant changes in these parameters, however the improvement was still remarkable in comparison to the pretreatment values (P < 0.003, P < 0.004, P < 0.000001, P < 0.000001 and P < 0.00001, respectively). A significant drop in markers of bone turnover (urinary deoxypyridinoline and serum osteocalcin) occurred after 3 years of therapy (P < 0.003 and 0.004, respectively). No adverse reactions were observed throughout the treatment. CONCLUSIONS Alendronate has positively influenced quality of life in paediatric patients with osteogenesis imperfecta. Bisphosphonate therapy should be used only in the context of a well-defined protocol.
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Affiliation(s)
- Václav Vyskocil
- Bone Disease Centre, Charles University Hospital, Pilsen, Czech Republic
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30
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Abstract
Osteogenesis imperfecta is a genetic disorder of increased bone fragility, low bone mass, and other connective-tissue manifestations. The most frequently used classification outlines four clinical types, which we have expanded to seven distinct types. In most patients the disorder is caused by mutations in one of the two genes encoding collagen type 1, but in some individuals no such mutations are detectable. The most important therapeutic advance is the introduction of bisphosphonate treatment for moderate to severe forms of osteogenesis imperfecta. However, at present, the best treatment regimen and the long-term outcomes of bisphosphonate therapy are unknown. Although this treatment does not constitute a cure, it is an adjunct to physiotherapy, rehabilitation, and orthopaedic care. Gene-based therapy presently remains in the early stages of preclinical research.
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Affiliation(s)
- Frank Rauch
- Genetics Unit, Shriners Hospital for Children and McGill University, 1529 Cedar Avenue, Montréal, Québec, Canada H3G 1A6
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