Article Text

Download PDFPDF
Systematic review of effectiveness of bisphosphonates in treatment of low bone mineral density and fragility fractures in juvenile idiopathic arthritis
  1. J Thornton1,
  2. D M Ashcroft2,
  3. M Z Mughal3,
  4. R A Elliott2,
  5. T W O’Neill1,
  6. D Symmons1
  1. 1Arthritis Research Campaign Epidemiology Unit, Division of Epidemiology and Health Sciences, University of Manchester, UK
  2. 2School of Pharmacy and Pharmaceutical Sciences, University of Manchester, UK
  3. 3Department of Paediatric Medicine, Saint Mary’s Hospital for Women & Children, Manchester, UK
  1. Correspondence to:
    Prof. D Symmons
    Arthritis Research Campaign Epidemiology Unit, Division of Epidemiology and Health Sciences, University of Manchester, Oxford Road, Manchester M13 9PT, UK; deborah.symmons{at}


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.

  • aBMD, areal bone mineral density
  • BMAD, bone mineral apparent density
  • BMC, bone mineral content
  • BMD, bone mineral density
  • DXA, dual energy x ray absorptiometry
  • JIA, juvenile idiopathic arthritis
  • juvenile idiopathic arthritis
  • bisphosphonates
  • systematic review
  • fragility fractures

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Published Online First 11 May 2006

  • Funding: this project was funded by the NHS R&D Programme Health Technology Assessment Programme (03/43/04)

  • Competing interests: none

  • The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Department of Health

Linked Articles

  • Précis
    BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health