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• Neonatal hypocalcaemic seizures secondary to pamidronate
  Mark L Anderson
  Published on: 4 May 2005

• Published on: 4 May 2005

  Neonatal hypocalcaemic seizures secondary to pamidronate

  • Mark L Anderson, Paediatric Specialist Registrar
  • Other Contributors:
    • Kate Palmer

  Dear Editor,

  We read with interest the article written by Shaw and Bishop [1] on the use of bisphosphonates and would like to report the following adverse reaction. A breast-fed full term neonate with clinically diagnosed osteogenesis imperfecta type III was treated on day nine of life with IV pamidronate (0.5mg/kg od for three days) on the advice of a tertiary centre. Serum calcium had been measured at 24 hours o...

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  Dear Editor,

  We read with interest the article written by Shaw and Bishop [1] on the use of bisphosphonates and would like to report the following adverse reaction. A breast-fed full term neonate with clinically diagnosed osteogenesis imperfecta type III was treated on day nine of life with IV pamidronate (0.5mg/kg od for three days) on the advice of a tertiary centre. Serum calcium had been measured at 24 hours of age and was 2.72 mmol/L (corrected) with a normal PTH of 1.4 pmol/l. Two days after the third dose, the baby had four short-lived generalised seizures. Ionised calcium measured at the time of the fits was 0.96 mmol/L and total serum calcium was 1.73 mmol/L. The remainder of the biochemistry was unremarkable. The serum calcium level was treated with an infusion of IV calcium gluconate and a short course of oral calcium supplements and rose rapidly. No further seizures were observed. We postulate that these seizures were caused by hypocalcaemia secondary to pamidronate therapy.

  The introduction of cyclical pamidronate therapy in recent years has been shown to be both effective and safe for the treatment of osteogenesis imperfecta in infants and young children.[2] Previous studies in children have demonstrated a mild drop in serum calcium levels following administration but none have described these as being severely symptomatic and levels rapidly return to normal driven by an elevation in parathormone production.[3,4] Hypocalcaemic seizures following bisphosphonate administration have only previously been reported in a 92 year old woman with vitamin D deficiency.[5] This is therefore the first report of hypocalcaemic seizures secondary to bisphosphonate administration in the neonatal age group. With the recommendation that bisphosphonates are used as early as possible in children with osteogenesis imperfecta to gain maximum benefit [6], monitoring of serum calcium levels is advisable when pamidronate is used in neonates.

  References

  1 Shaw NJ, Bishop NJ. Bisphosphonate treatment of bone disease. Arch Dis Child 2005; 90:494-499.

  2 Glorieux FH, Bishop NJ, Plotkin H, Chabot G, Lanoue G, Travers R Cyclical administration of pamidronate in children with severe osteogenesis imperfecta. N Eng J Med 1998; 339:947-952.

  3 Rauch F, Plotkin H, Travers R, Zeitlin L, Glorieux FH. Osteogenesis Imperfecta Types I, III and IV: Effect of Pamidronate Therapy on Bone and Mineral Metabolism. J Clin Endocrinol Metab 2003; 88:986-992.

  4 Astrom E, Soderhall S. Beneficial effect of long term intravenous bisphosphonate treatment of osteogenesis imperfecta. Arch Dis Child 2002; 86:356-364.

  5 Maclsaac RJ, Seeman E, Jerums G. Seizures after alendronate. J R Soc Med 2002; 95:615-616.

  6 Plotkin H, Rauch F, Bishop NJ, Montpetit K, Ruck-Gibis J, Travers R, Glorieux FH. Pamidronate treatment of severe osteogenesis imperfecta in children under 3 years of age. J Clin Endocrinol Metab 2000; 85:1846-50.

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  Conflict of Interest:
  None declared.

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