Pediatric Osteoporosis Medication

Updated: May 25, 2016
  • Author: Manasa Mantravadi, MD, MS; Chief Editor: Jatinder Bhatia, MBBS, FAAP  more...
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Medication

Medication Summary

Therapy includes antiresorptive agents such as bisphosphonates (eg, alendronate, risedronate, pamidronate, zoledronic acid) as well as calcium and vitamin D supplementation. Hormone replacement therapy (eg, estrogen, estrogen analogs) does not have a role in pediatric therapy unless the low bone mass is attributable to hypogonadism.

Preferred treatment of Vitamin D Deficiency is listed below [9] :

Table 5: Treatment of Vitamin D Deficiency (Open Table in a new window)

AgePreparation and Dosea                                                                                
Infants, 0–12 moVitamin D2 or D3 50 000 IU weekly for 6 wk 



 



or



Vitamin D2 or D3 2000 IU daily for 6 wk
Followed by a maintenance dose of 400–1000 IU daily                                                Followed by a maintenance dose of 400–1000 IU daily                             
Children and adolescents, 1–18y                                                        Vitamin D2 or D3 50 000 IU weekly for 6-8 wk 



 



or



 



 



 



Vitamin D2 or D3 2000 IU daily for 6–8 wk
Followed by a maintenance dose of 600–1000 IU dailyFollowed by a maintenance dose of 600–1000 IU daily

See the list below:

  • Vitamin D2, ergocalciferol; vitamin D3, cholecalciferol.
  • a Vitamin D3 may be more potent than vitamin D2.

Table from: Golden NH, Abrams SA, Committee on Nutrition. Optimizing bone health in children and adolescents. Pediatrics. 2014 Oct. 134 (4):e1229-43.

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Bisphosphonate bone-resorption inhibitors

Class Summary

These agents decrease bone resorption and prevent bone loss from diminishing bone mass on an ongoing basis. They are available in parenteral and oral dosage forms for acute and chronic treatment, respectively.

Pamidronate (Aredia)

Pamidronate inhibits both normal and abnormal bone resorption. It appears to inhibit bone resorption without as much impact on bone formation and mineralization. It is administered intravenously (IV), using a variety of regimens. Pamidronate is approved for use in hypercalcemia of malignancy and Paget disease. It has also been used in children with osteopenic bone disease.

Alendronate (Fosamax)

Alendronate is an orally administered bisphosphonate that is approved as an antiresorptive agent to treat Paget disease and postmenopausal osteoporosis.  Although a large trial of low dose alendronate did not show benefits for children with OI, the studies with higher doses have showed greater efficacy.

Risedronate (Actonel)

Risedronate is an aminobisphosphonate. It inhibits bone resorption via actions on osteoclasts or osteoclast precursors. It is indicated for the prevention and treatment of osteoporosis.  It has been demonstrated to have efficacy in children with mild/moderate OI.

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Vitamin Supplementation

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Calcium

Calcium

For optimal bone health, dietary sources of required daily calcium should be recommended in preference to calcium supplements, not only because of the improved bioavailability of dietary sources of calcium, but also to encourage lifelong healthy dietary habits for children and adolescents. The most commonly consumed dietary sources of calcium are milk, other dairy-containing products, and calcium-fortified juices.  Oral calcium either as dietary intake or supplement should be routinely used in conjunction with vitamin D in the treatment of Vitamin D deficiency regardless of age or weight. The dose of a supplement can be selected based primarily on the content of elemental calcium. The most widely available calcium supplements are calcium carbonate and calcium citrate.

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Vitamin D

Vitamin D

Although routine 25OHD screening is not recommended for healthy children, children at risk of osteoporosis or vitamin D deficiency (with factors/conditions that reduce vitamin D synthesis or intake) should have their vitamin D status ascertained by measurement of a serum 25OHD concentration. Deficiency is defined as a concentration < 30 nmol/L and insufficiency a concentration 30–50 nmol/L, Deficiency, <30 nmol/L). 

For treatment of nutritional rickets per the most recent Global Consensus Recommendations, the minimal recommended dose of vitamin D is 2000 IU/d (50 μg) for a minimum of 3 months. Oral treatment is preferred to intramuscular therapy.  For daily treatment, both D2 and D3 are equally effective. When single large doses are used, D3 appears to be preferable compared to D2 because the former has a longer half-life. Vitamin D treatment is recommended for a minimum of 12 weeks, recognizing that some children may require longer treatment duration.

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