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THE EFFICACY OF INTRAVENOUS PAMIDRONATE IN THE TREATMENT OF GASTROINTESTINAL DISEASE-RELATED BONE LOSS (GDBL)
K Qumosani, T Paul, J Gregor
Department of Medicine, University of Western Ontario, London, Ontario
BACKGROUND: Osteoporosis and osteopenia are increasingly recognized complications of gastrointestinal diseases and their treatment. Oral bisphophonates have been shown to not only prevent but reverse such bone loss and prevent fractures. Oral administration of these medications can be difficult in patients with gastrointestinal disease because of generally poor absorption and a high incidence of gastrointestinal side effects, leading to problems with disease management and patient compliance. Intravenous administration though perceived as cumbersome, may be an effective means of overcoming these difficulties.
METHODS: We evaluated 22 consecutive patients with GDBL (13 Crohn’s disease, 7 celiac disease, 1 radiation enteropathy, and 1 sclerosing cholangitis) who received intravenous pamidronate 30-60mg every three months for a minimum of two years. Bone mineral density (BMD) was assessed prior to and after the two years of therapy. A paired t-test was used to statically compare the difference in bone density prior to and after treatment. An unpaired t-test was used to compare across disease states.
RESULTS: Analyzing all patients together showed a significant mean improvement in BMD for the femoral neck (0.0383 g/cm3, p= 0.0035). Improvement in mean BMD for lumber spine was 0.0278 g/cm3 but statistically was not significant (p=0.2007). Disease specific analysis for the femoral neck revealed a mean improvement of 0.04369 g/cm3 in patients with Crohn’s disease and 0.03000 g/cm3 in celiac disease (p= 0.62). For the lumbar spine, the mean improvements were 0.01823 g/cm3 and 0.04214 g/cm3 respectively (p= 0.63).
CONCLUSION: Intravenous pamidronate consistently improves femoral neck bone density in patients with GDBL and may also be effective in treating GDBL in the lumbar spine. The effect does not appear to be disease specific.