Bisphosphonates in Pediatric Burn Injury

Abstract

Burn injury in children triggers a series of nonspecific adaptive responses. Among them are the systemic inflammatory response and the stress response, as well as a consequent period of relative immobilization. It is likely that both the systemic inflammatory response through the production of cytokines and the stress response, through the production of endogenous glucocorticoids, stimulate acute bone loss by means of excess bone resorption followed by osteoblastic apoptosis caused by the endogenous glucocorticoids, which make it impossible to repair the bone loss by making new bone. In this chapter we describe two studies that demonstrate that the acute administration of the antiresorptive bisphosphonate pamidronate is able to not only prevent the acute post-burn bone loss but also permit continued new bone mass accretion with time. The lack of side effects suggests that this drug can be used both safely and effectively in pediatric burn patients to prevent bone loss and the manner of its successful use may have applications to other pediatric conditions, which will be discussed.