Systematic review of effectiveness of bisphosphonates in treatment of low bone mineral density and fragility fractures in juvenile idiopathic arthritis

Judith Thornton ¹, Darren M Ashcroft ¹, Zulf Mughal ², Rachel A Elliott ¹, Terry W O'Neill ¹ and Deborah Symmons ^1*

¹ University of Manchester, United Kingdom
² St Mary's Hospital for Women and Children, United Kingdom

^* To whom correspondence should be addressed. E-mail: deborah.symmons{at}man.ac.uk.

Accepted 26 April 2006

Abstract

Objective:To evaluate the currently-available evidence for the effectiveness of bisphosphonates in children with low bone mineral density (BMD) and fragility fractures associated with 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 and 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 (RCT), 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 3 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.

Keywords: bisphosphonates, children, fragility fractures, juvenile idiopathic arthritis, systematic review

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Relevant Article

A brief digest of the September issue
Arch. Dis. Child. 2006 91: e5. [Extract] [Full Text] [PDF]