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Cited by 108Bone health and osteoporosis researchBone health and treatmentsBone Metabolism and Diseases

Effects of once-weekly oral alendronate on bone in children on glucocorticoid treatment

Rudge, S., Hailwood, S., Horne, A., Lucas, J., Wu, F., Cundy, T.·2005·Rheumatology
DOI 10.1093/rheumatology/keh538
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Abstract

OBJECTIVES: To determine the effects of once-weekly oral alendronate on indices of bone size, density and resorption in children with chronic illness being treated with glucocorticoids. METHODS: Twenty-two children with chronic illness treated with prednisone were randomized to receive 1 year's treatment with either once-weekly oral placebo or alendronate (1-2 mg/kg body weight) in a double-blind study. The main outcome measures were changes in lumbar spine and femoral shaft size and volumetric density (measured by dual energy X-ray absorptiometry) and N-telopeptide excretion (a marker of bone resorption). RESULTS: Once-weekly alendronate was well tolerated, and there were no major adverse events. In both groups bone size and bone mineral content increased through growth. Volumetric bone density of the lumbar spine increased significantly in the alendronate group (P = 0.013), but not in the placebo group. There were no differences between the groups in growth in the cortical width of the femoral shaft, but the cross-sectional moment of inertia per unit length-a derived estimate of mechanical strength-increased significantly in the alendronate group (P = 0.014) but not in the placebo group. Urine N-telopeptide excretion was suppressed significantly in the alendronate group (P = 0.007) but not in the placebo group. Height velocity was positively correlated with changes in both lumbar spine area and the total width of the femoral shaft (P = 0.015, P = 0.026, respectively). CONCLUSION: Once-weekly oral alendronate is well tolerated, suppresses bone resorption and may improve volumetric bone density at the lumbar spine and mechanical strength of the femoral shaft in children with chronic illness taking glucocorticoids. It does not affect bone growth. Larger controlled studies are needed to determine if these changes translate into reduced fracture incidence or greater peak bone mass. This study highlights the importance of differentiating between changes in bone size and changes in volumetric bone density in assessing bone in children, and also having control subjects in intervention studies.

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  • The use of bisphosphonates is not ideal in a growing skeleton because they inhibit bone remodeling and could increase the mineral in the bone matrix.

    “However, as bone is highly remodeled during childhood to maintain adequate mineralization of the rapidly growing skeleton, the use of BPs is not ideal as they inhibit bone remodeling and could increase the mineral in the bone matrix, which may not be ideal to use in a growing skeleton [16, 17].”

    From Prevention of glucocorticoid induced bone changes with beta-ecdysone (2015) · cites this paper as [17]

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Research works printed but not linked: 2

  1. Bianchi M, Cimaz R, Bardare M et al. Efficacy and safety of alendronate for the treatment of osteoporosis in diffuse connective tissue diseases in children: a prospective multicenter study. Arthritis Rheum 2000;43:1960-6.
  2. Hayes W, Gerhart T. Biomechanics of bone: applications for assessment of bone strength. J Bone Miner Res 1985;3:259-94.

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Authors
Rudge, S., Hailwood, S., Horne, A., Lucas, J., Wu, F., & Cundy, T.
Affiliations
  • University of Auckland (NZ)
  • Starship Children's Health (NZ)
Corresponding author
Rudge, S.
ORCID
Venue
Rheumatology
Publisher
Oxford University Press (OUP)
Published
2005-02-03
Volume
44
Issue
6
Pages
813-818
ISSN
  • 1462-0324 (ISSN-L)
  • 1462-0332
DOI
10.1093/rheumatology/keh538
OpenAlex
W2170105881
Cited by
108
References
34
Citations by year
2026: 3 · 2025: 3 · 2024: 6 · 2023: 5 · 2022: 7 · 2021: 2 · 2020: 5 · 2019: 3 · 2018: 4 · 2017: 5 · 2016: 5 · 2015: 8 · 2014: 6 · 2013: 3 · 2012: 4
FWCI
6.75
Type
journal article
Language
en
Open access
closed
Locations
  • Lara D. Veeken (publishedVersion)
  • PubMed (publishedVersion)
  • Bristol Research (University of Bristol) (submittedVersion)
  • Explore Bristol Research (submittedVersion)
  • ResearchSpace (University of Auckland) (submittedVersion)
Funders
  • Maurice and Phyllis Paykel Trust
  • Health Research Council of New Zealand
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Health Sciences › Medicine › Oncology › Bone health and treatments
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Bone Metabolism and Diseases
Keywords
alendronate, glucocorticoid-induced osteoporosis, prednisone, children with chronic illness, bone mineral density, bone resorption, N-telopeptide, lumbar spine, femoral diaphysis, bone strength, height velocity, peak bone mass, fracture prevention
MeSH terms
Administration, Oral, Adolescent, Arthritis, Juvenile, Body Height, Bone Resorption, Child, Child, Preschool, Collagen, Dermatomyositis, Double-Blind Method, Drug Administration Schedule, Female, Femur, Glucocorticoids, Humans, Lumbar Vertebrae, Lupus Erythematosus, Systemic, Male, Peptides, Prednisone, Stress, Mechanical, Bone Density, Alendronate, Collagen Type I

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