Effect of intravenous pamidronate on bone mineral density in adults with cystic fibrosis

Background-Low bone mineral density (BMD) is prevalent in adults with cysti c fibrosis. The aim of this study was to assess the effect of intravenous p amidronate on BMD in these subjects. Methods-Patients were invited to participate if they had a BMD Z score of - 2 or less in the lumbar spine, proximal femur, or distal forearm. Patients were randomised to receive either 30 mg intravenous pamidronate every 3 mon ths + 1 g calcium daily (pamidronate group) or 1 g calcium daily (control g roup). AU pancreatic insufficient patients were prescribed oral vitamin D s upplements. Results-After 6 months of treatment the pamidronate group (n=13) showed a s ignificant increase in absolute BMD compared with the control group (n=15) in the lumbar spine (mean difference 5.8% (CI 2.7% to 8.9%)) and total hip (mean difference 3.0% (CI 0.3% to 5.6%)). However, the pamidronate group sh owed a reduction in BMD compared with the control group in the distal forea rm (mean difference -1.7% (CI -3.7% to 0.3%)). The use of pamidronate was a ssociated with a high incidence of bone pain in non-corticosteroid treated individuals. Conclusion-Intravenous pamidronate increases axial EMD in adults with cysti c fibrosis, but the high incidence of bone pain associated with this treatm ent might limit its use.