TREATMENT OF POST MENOPAUSAL OSTEOPOROSIS WITH INTRAVENOUS PAMIDRONATE IN PATIENTS WITH ESOPHAGOGASTRIC PATHOLOGY

Pamidronate is an effective inhibitor of bone resorption; for this rea son it is used in the treatment of high bone turnover diseases and ost eoporosis. Because of potential gastric and esophagic side effects the ir oral use is limited in patients with active pathology in these orga ns. With the aim to evaluate the usefulness and to establish the ideal schedule of treatment of intravenous pamidronate, we assayed pamidron ate infusions (APDIV) in 20 postmenopausal women with active gastroeso phagical diseases. Ten of these patients received 30 or 45 mg weekly u ntil they achieved an average dose of 157.50 +/- 9.28 mg/year in one m onth (range: 120-180 mg) (Group A). Another comparable ten women's gro up received 30 or 45 mg every three months or 90 mg every six months; the achieved average dose in this group was 166.50 +/- 6.87 mg/year (r ange: 120-180 mg) (Group B). All patients received 1 000 mg elemental calcium daily. Bone mineral density in lumbar spine significantly incr eased in both groups, but this increment (Delta DMO%) was higher in gr oup B. Bone mineral density in femoral neck was only increased in grou p A. Parathyroid hormone (iPTH) significantly increased at the third m onth but returned to basal values at the end of the year in both group s. Parameters of bone remodeling such as osteocalcin (BGP), pyridinoli ne and deoxipyridinolin decreased progressively and remained low at th e end of the year. The treatment was well tolerated: only two patients in group A and one in Group B experienced fever and pseudoflu syndrom e; phlebitis was present in one patient in the second group. In conclu sion, intravenous Pamidronate is an effective and safe treatment for p ostmenopausal osteoporosis specially in these patients with esophagico r gastric disorders, Future trials are needed to clarify the ideal dos e and schedule of treatment.