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Pamidronate is also known as Aredia and it is in a class of drugs known as bisphosphonates.
Bisphosphonates have been used to treat osteoporosis as well as hypercalcemia due to malignancy(but it is not a cancer drug).Bisphosphonates
act to slow down the cells in bones that are constantly breaking down bone(osteoclasts) and allowing the cells that make bone(osteoblasts)
to catch up and get ahead. Therefore PAM acts to increase the structure or density of the bones but the bone is still abnormal
in the case of Type III's and IV's. PAM works specially well on the vertebral column and decreases spinal compression
fractures therefore allowing greater height and less deformity. It also decreases microfractures which helps with the chronic
pain and fatigue and the majority of us notice our little ones having tremendous energy a few hours to days after their treatment
and that this slowly wanes as it gets closer to infusion time. The lack of bone pain allows the kids to use there muscles
more and the stronger muscles are also protective of the bones. Physical therapy is very important to all kids with OI and
I strongly encourage this.Children on PAM are more likely to be ambulatory, have less fractures, less fatigue and are
growing at a higher rate than their non PAM OI peers. PAM is not for every OI kid and it needs to be given in association
with a well trained OI specialist.
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Pamidronate is given to
increase bone density by slowing down bone breakdown. This has been shown to strengthen bones, decrease bone pain and increase
exercise tolerance. Dosing frequency is adjusted according to speed of bone growth. In newborns and infants the interval is
6-8 weeks and as they reach about 2-3 years it goes to 8- 12 weeks and somewhere around 4-5 maybe every 4-6 months. The older
children are now being allowed to adjust their dosing by return of bone pain and fatigue. Adjustments are made to this schedule
by dexa scan readings because their is a fear of making the bone too dense and that increases frequency of breaks. Pam may
increase overall growth by decreasing fractures at the growth plates and decreasing spinal compression fractures. |
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