Journal Mobile Options
Table of Contents
Vol. 102, No. 3-4, 2006
Issue release date: February 2006
Nephron Clin Pract 2006;102:c81–c87

Pamidronate Therapy for Preventing Steroid-Induced Osteoporosis in Children with Nephropathy

Kim S.-D. · Cho B.-S.
East-West Kidney Disease Research Institute and Department of Pediatrics, Kyung Hee University Hospital, Hoegi-dong, Dongdaemun-gu,Seoul, Korea

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Background: Steroid-induced osteoporosis (SIO) is a serious complication of long-term steroid therapy and is of particular concern in growing children. Recently bisphosphonates have been applied in the treatment or prevention of SIO. We investigated the efficacy of pamidronate on SIO in childhood nephropathy patients receiving long-term corticosteroid therapy. Methods: Forty-four children receiving high doses of steroids were enrolled in the study. There was no history of bone, liver, or endocrine disease. Patients were randomly classified into two groups, the control group and the study group. All patients received corticosteroids for 3 months. Control group took oral calcium supplements (500 mg/day) only, and the study group oral calcium and pamidronate (125 mg) for 3 months. Biochemical tests, long bone radiography, and bone mineral density (BMD) were performed in the first month and 3 months later in all patients. Results: The differences in the results of biochemical tests such as serum calcium, BUN, and cre atinine level obtained in the first month and three months later were not of statistical significance in both the control and the study groups. However, the mean BMD of the lumbar spine decreased from 0.654 ± 0.069 (g/cm2) to 0.631 ± 0.070 (g/cm2) in the control group (p = 0.0017), while it did not in the study group from 0.644 ± 0.189 (g/cm2) to 0.647 ± 0.214 (g/cm2). Conclusions: Pamidronate appears to be effective in preventing SIO in children with nephropathy requiring long-term steroid therapy. Further long-term follow-up studies regarding the efficacy and side effects appear to be necessary to set a more solid basis for such pediatric uses of bisphosphonates such as pamidronate.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Eddy AA, Symons JM: Nephrotic syndrome in childhood. Lancet 2003;23:629–639.
  2. Lettgen B, Jeken C and Reiners C: Influence of steroid medication on bone mineral density in children with nephrotic syndrome. Pediatr Nephrol 1994;8:667–670.
  3. Uzu T, Harada T, Ko M, Yamato M, Takahara K, Yamauchi A: Effect of corticosteroid therapy on the progression of IgA nephropathy with moderate proteinuria. Clin Exp Nephrol 2003;7:210–214.
  4. Gulati S, Godbole M, Singh U, Gulati K, Srivastava A: Are children with idiopathic nephrotic syndrome at risk for metabolic bone disease? Am J Kidney Dis 2003;41:1163–1169.
  5. Lang P, Steiger P, Faulkner K, Guller L and Genant HK: Osteoporosis: Current techniques and recent development in quantitative bone densitometry. Radiol Clin North Am 1991;29:49–76.
  6. Eberhardt AW, Yeager-Jones A, Blair HC: Regional trabecular bone matrix degeneration and osteocyte death in femora of glucocorticoid-treated rabbits. Endocrinology 2001;142:1333–1340.
  7. Torregrosa JV, Moreno A, Gutierrez A, Vidal S, Oppenheimer F: Alendronate for treatment of renal transplant patients with osteoporosis. Transplant Proc 2003;35:1393–1395.
  8. Mirzaei S, Zajicek HK, Knoll P, Hahn M, Levi M, Kohn H, Pohl W: Effect of rocaltrol on bone mass in patients with pulmonary disease treated with steroids. J Asthma 2003;40:251–255.
  9. Loddenkemper K, Grauer A, Burmester GR, Buttgereit F: Calcium, vitamin D and etidronate for the prevention and treatment of steroids-induced osteoporosis in patients with rheumatic diseases. Clin Exp Rheumatol 2003;21:19–26.
  10. Amin S, Lavalley MP, Simms RW, Felson DT: The comparative efficacy of drug therapies used for the management of steroids-induced osteoporosis: a meta-regression. J Bone Miner Res 2002;17:1512–1526.
  11. Reid DM, Adami S, Devogelaer JP, Chines AA: Risedronate increases bone density and reduces vertebral fracture risk within one year in men on steroids therapy. Calcif Tissue Int 2001;69:242–247.
  12. Saag KG, Emkey R, Schnitzer TJ, Brown JP, Hawkins F, Goemaere S, Thamsborg G, Liberman UA, Delmas PD, Malice MP, Czachur M, Daifotis AG: Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis: Glucocorticoid-Induced Osteoporosis Intervention Study Group. N Engl J Med 1998;339:292–299.
  13. Matsumoto H, Ishihara K, Hasegawa T, Umeda B, Niimi A, Hino M: Effects of inhaled steroids and short courses of oral steroids on bone mineral density in asthmatic patients: a 4-year longitudinal study. Chest 2001;120:1468–1473.
  14. Eastell R, Devogelaer JP, Peel NF, Chines AA, Bax DE, Sacco-Gibson N, Nagant de Deuxchaisnes C, Russell RG: Prevention of bone loss with risedronate in glucocorticoid-treated rheumatoid arthritis patients. Osteoporos Int 2000;11:331–337.
  15. Cunnane G, Lane NE: Steroid-induced osteoporosis in systemic lupus erythematosus. Rheum Dis Clin North Am 2000;26:311–329.
  16. von Tirpitz C, Klaus J, Bruckel J, Rieber A, Scholer A, Adler G, Bohm BO, Reinshagen M: Increase of bone mineral density with sodium fluoride in patients with Crohn’s disease. Eur J Gastroenterol Hepatol 2000;12:19–24.
  17. Chavassieux P, Pastoureau P, Chapuy MC, et al: Glucocorticoid-induced inhibition of osteoblastic bone formation in ewes: a biochemical and histomorphometric study. Osteoporos Int 1993;3:97–102.
  18. Dequeker J, Westhovens R: Low dose corticosteroid associated osteoporosis in rheumatoid arthritis and its prophylaxis and treatment: bones of contention. J Rheumatol 1995;22:1013–1019.
  19. Adami S, Fossaluzza V, Rossini M, Bertoldo F, Gatti D, Zamberlan N, Lo Cascio V: The prevention of corticosteroid-induced osteoporosis with nandrolone decanoate. Bone Miner 1991;15:73–81.
  20. Lukert BP and Raisz LG: Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med 1990;112:352–364.
  21. Lettgen B, Jeken C, Reiners C: Influence of steroid medication on bone mineral density in children with nephrotic syndrome. Pediatr Nephrol 1994;8:667–670.
  22. Wark JD: Osteoporotic fracture: background and prevention strategies. Maturitas 1996;23:193–207.
  23. Noguera A, Ros JB, Pavia C, Alcover E, Valls C, Villaronga M, Gonzalez E: Bisphosphonates, a new treatment for glucocorticoid-induced osteoporosis in children. J Pediatr Endocrinol Metab 2003;16:529–536.
  24. Jones G, Hogan DB, Yendt E, Hanley DA: Prevention and management of osteoporosis: consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada. 8. Vitamin D metabolites and analogs in the treatment of osteoporosis. CMAJ 1996;155:955–961.
  25. Batch JA, Couper JJ, Rodda C, Cowell CT, Zacharin M: Use of bisphosphonate therapy for osteoporosis in childhood and adolescence. J Paediatr Child Health 2003;39:88–92.
  26. Rogers MJ, Frith JC, Luckman SP, Coxon FP, Benford HL, Monkkonen J, Auriola S, Chilton KM, Russell RG: Molecular mechanisms of action of bisphosphonates. Bone 1999;24:73S–79S.

    External Resources

  27. Kanis JA, Melton J, Christiansen C, Johnston CC and Khaltaev N: The diagnosis of osteoporosis. J Bone Miner Res 1994;9:1137–1141.
  28. Ernesto Canalis, John P. Bilezikian, Alberto Angeli, Andrea Giustina: Perspectives on glucocorticoid-induced osteoporosis. Bone 2004;34:593–598.
  29. Hoekman K, Papapoulos SE, Peters AC, Bijvoet OL: Characteristics and bisphosphonate treatment of a patient with juvenile osteoporosis. J Clin Endocrinol Metab 1985;61:952–956.
  30. Glorieux FH, Bishop NJ, Plotkin H, Chabot G, Lanoue G, Travers R: Cyclic administration of pamidronate in children with severe osteogenesis imperfecta. N Engl J Med 1998;339:947–952.
  31. Dimeglio LA, Ford L, McClintock C, Peacock M: A comparison of oral and intravenous bisphosphonate therapy for children with osteogenesis imperfecta. J Pediatr Endocrinol Metab 2005;18:43–53.
  32. Zacharin M, Bateman J: Pamidronate treatment of osteogenesis imperfecta-lack of correlation between clinical severity, age at onset of treatment, predicted collagen mutation and treatment response. J Pediatr Endocrinol Metab 2002;15:163–174.
  33. Brumsen C, Hamdy NA, Papapoulos SE: Long-term effects of bisphosphonates on the growing skeleton: studies of young patients with severe osteoporosis. Medicine (Baltimore) 1997;76:266–283.
  34. Silverman SL, Hurvitz EA, Nelson VS, Chiodo A: Rachitic syndrome after disodium etidronate therapy in an adolescent. Arch Phys Med Rehabil 1994;75:118–120.
  35. Liens D, Delmas PD, Meunier PJ: Long-term effects of intravenous pamidronate in fibrous dysplasia of bone. Lancet 1994;343:953–954.
  36. Samuel R, Katz K, Papapoulos SE, Yosipovitch Z, Zaizov R, Liberman UA: Aminohydroxy propylidene bisphosphonate (APD) treatment improves the clinical skeletal manifestations of Gaucher’s disease. Pediatrics 1994;94:385–389.
  37. van Persijn van Meerten EL, Kroon HM, Papapoulos SE: Epi- and metaphyseal changes in children caused by administration of bisphosphonates. Radiology 1992;184:249–254.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50