Corresponding Author: Fernando Santos, MD, PhD, Pediatria. Facultad de Medicina. c/ Julian Claveria 6, 33006 Oviedo, Asturias, Spain (Tel: +34985102728; Fax: +34985103585; Email: fsantos@uniovi.es)

Background: Bisphosphonates are being increasingly and successfully used to prevent bone fractures and treat bone pain in children with severe osteoporosis from different origins. The purpose of this article is to update the clinical use of bisphosphonates in pediatric patients and to present the authors' experience with the intravenous administration of pamidronate in osteopenic children.  

Data sources: PubMed database was used to collect publications reporting the utilization of bisphosphonates in children. The medical records of five pediatric patients treated in our unit with bisphosphonates were also reviewed.  

Results: A growing experience is accumulating with the cyclical intravenous administration of pamidronate in children with osteogenesis imperfecta. Bisphosphonates may also be useful in the prevention and treatment of vascular calcification in patients with chronic renal failure, although no data on children in this clinical setting are available.  

Conclusions: Intravenous bisphosphonates are well tolerated, even in infants and small children, and represent a promising therapeutic tool to prevent the development of bone fractures and to improve the well-being of osteoporotic children. A number of questions about the precise clinical indications for bisphosphonates' administration, the duration of the treatment, the best way to monitor its effectiveness and to early detect toxic effects remain to be answered. 

Key words: bisphosphonates; pamidronate; osteoporosis; osteogenesis imperfecta; calcification; chronic renal failure; hypercalcemia; bone diseases; kidney diseases

                   World J Pediatr 2007;3(4):245-253