Bisphosphonates: From grandparents to grandchildren

Bisphosphonates are synthetic analogues of pyrophosphate that inhibit bone resorption by their action on osteoclasts. Bisphosphonates have been extens ively used in the elderly with primary and secondary osteoporosis, Paget's disease, and hypercalcemia of malignancy. In recent years, bisphosphonates have been used to treat children acutely for resistant hypercalcemia and ch ronically for various metabolic bone diseases. The theoretical concerns of possible adverse effects of these drugs on the growing skeleton have not be en proven to be true. In the present review, we have critically analyzed th e available literature on bisphosphonate therapy in both adult and pediatri c clinical trials. Although not yet approved by the FDA for use in children , bisphosphonates, from published experience, demonstrate benefit to the ch ild with no serious adverse effects. Based on the literature analysis the r eview furnishes detailed recommendations and practical guidelines regarding the use of oral and intravenous bisphosphonates in children. Bisphosphonat es might be the first agents to provide the pediatrician with an opportunit y to treat mineral and bone disorders of childhood, which until recently di d not have satisfactory therapy.