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Effective parenteral clodronate treatment of a child with severe juvenile idiopathic osteoporosis

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Abstract

We report on an 8 years and 3 months old boy with severe idiopathic juvenile osteoporosis (IJO). Clinical features included multiple fractures, especially of the vertebrae, and neurological symptoms. Biological studies showed non-parathyroid hormone-mediated excessive bone resorption and massive urinary calcium loss. Although IJO is usually a self-limiting condition after puberty, the severity of our patient’s manifestations required therapeutic intervention. Clodronate (dichloromethylene-bisphosphonate) was administered parenterally every 3 months for a period of 2 years. Dramatic clinical and biochemical improvement was noted within 2 weeks. All parameters of bone resorption normalised and no new fractures occurred. After 6 months of treatment, radiological improvement with healing of fractures and rebuilding of the vertebral plates was documented. Bone mineral density increased to normal within 1 year and growth velocity was accelerated. After 2 years, treatment was stopped at the age of 10 years and 3 months. One year later, back pain and increasing pain in the knee region recurred. A tibial fracture was evident and, again, bone mineral density was far below normal. Bisphosphonate medication was reinstituted leading to rapid improvement. No side-effects were observed. Conclusion:parenteral clodronate therapy is effective in managing severe idiopathic juvenile osteoporosis.

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Abbreviations

DPD :

desoxypyridinoline-crosslinks

IJO :

idiopathic juvenile osteoporosis

PTH :

parathyroid hormone

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Author notes

  1. Ralph Melchior

    Present address: , Garde-du-Corps-Strasse 7, 34117, Kassel, Germany

Authors and Affiliations

  1. Children’s Hospital, Klinikum Kassel, Kassel, Germany

    Ralph Melchior

  2. University Children’s Hospital, Mainz, Germany

    Ralph Melchior, Bernard Zabel, Jürgen Spranger & Roland Schumacher

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  1. Ralph Melchior
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  2. Bernard Zabel
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  3. Jürgen Spranger
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  4. Roland Schumacher
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Correspondence to Ralph Melchior.

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Melchior, R., Zabel, B., Spranger, J. et al. Effective parenteral clodronate treatment of a child with severe juvenile idiopathic osteoporosis. Eur J Pediatr 164, 22–27 (2005). https://doi.org/10.1007/s00431-004-1541-7

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  • DOI: https://doi.org/10.1007/s00431-004-1541-7

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