Efficacy and Safety of Oral Alendronate Treatment in Children and Adolescents with Osteoporosis

OBJECTIVES: To evaluate the efficacy and safety of oral alendronate on bone mineral density (BMD) in children and adolescents with osteoporosis. METHODS: Oral alendronate was given to 22 patients with an average age of 13.3 +/- 3.9 years (range 4.3-19 years) and BMD z-score < or = -2. Thirteen of them were treated with steroids. Dual-energy X-ray absorptiometry (DEXA) was used to measure lumbar vertebral BMD before and 14 +/- 7.75 months after treatment. Auxological, biochemical (Ca, P, alkaline phosphatase [ALP]) and densitometric parameters before and after treatment were compared for all patients. Responses of the patients taking steroids were compared with those who did not. RESULTS: Post-treatment z-scores of patients were significantly higher than basal values (p < 0.001). Average annual BMD increase with treatment was 32.74 +/- 52.57% (5.17 to 255.42%). Z-score and annual BMD increase in patients taking no steroids were significantly higher than the others (p = 0.020 and p = 0.006, respectively). Post-treatment serum ALP levels were significantly lower than their pretreatment levels (p = 0.007). After 1 year of treatment, osteoporosis completely recovered in six patients (28.6%), improved to osteopenia levels in seven patients (33.3%), continued although the z-score was increased in six patients (28.6%), and worsened in two patients (9.5%). There was no significant difference between the height standard deviation scores (SDS) of patients before and after treatment (p = 0.022). No side effect was observed due to alendronate treatment during the study. CONCLUSION: It is concluded that oral alendronate increases BMD without any side effects in osteoporotic children and adolescents, and it is cheaper and is easier to use than i.v. bisphosphonates.