This uncontrolled observational study tested cyclic IV pamidronate in 30 children (ages 3-16) with severe osteogenesis imperfecta. Treatment was given every 4-6 months for 1.3 to 5.0 years. The study asks whether bisphosphonate-mediated suppression of bone resorption can improve bone density, reduce fractures, and restore function.
When you see a child with OI type III or IV — wheelchair-dependent, multiple fractures per year, chronic pain. Cyclic IV pamidronate is the intervention that changes the trajectory.
Before this paper, no agent had demonstrated sustained improvement in severe OI. Anabolic steroids, fluoride, magnesium, and calcitonin had all failed. Glorieux's 1998 cohort was the first large series to show that bisphosphonates could cut fracture rates by 75%, rebuild vertebral height, and get wheelchair-bound children walking.
The safety profile matters as much as the efficacy. Growth, fracture healing, and growth plate architecture were all preserved. The acute-phase reaction after the first infusion is nearly universal (87%) but self-limited. Counsel families it will not recur.
This paper is why IV pamidronate (and later zoledronic acid) became the standard of care for severe pediatric OI, and why bisphosphonate therapy is now integrated into multidisciplinary OI programs alongside corrective rodding surgery and physiotherapy.
This uncontrolled observational study tested cyclic IV pamidronate in 30 children (ages 3-16) with severe osteogenesis imperfecta. Treatment was given every 4-6 months for 1.3 to 5.0 years. The study asks whether bisphosphonate-mediated suppression of bone resorption can improve bone density, reduce fractures, and restore function.
When you see a child with OI type III or IV — wheelchair-dependent, multiple fractures per year, chronic pain. Cyclic IV pamidronate is the intervention that changes the trajectory.
Before this paper, no agent had demonstrated sustained improvement in severe OI. Anabolic steroids, fluoride, magnesium, and calcitonin had all failed. Glorieux's 1998 cohort was the first large series to show that bisphosphonates could cut fracture rates by 75%, rebuild vertebral height, and get wheelchair-bound children walking.
The safety profile matters as much as the efficacy. Growth, fracture healing, and growth plate architecture were all preserved. The acute-phase reaction after the first infusion is nearly universal (87%) but self-limited. Counsel families it will not recur.
This paper is why IV pamidronate (and later zoledronic acid) became the standard of care for severe pediatric OI, and why bisphosphonate therapy is now integrated into multidisciplinary OI programs alongside corrective rodding surgery and physiotherapy.