Firstly, the indications for using bisphosphonates in PFD have not been specified. Currently, bisphosphonates are recommended for symptomatic cases such as those with bone pain or recent fractures(2). The current evidence does not favor the use of bisphosphonates in asymptomatic patients as this therapy does not lead to refilling of dysplastic lesions in children and adolescents as opposed to adults(3). Also, it needs to be emphasized that treatment needs to be continued for a long period, such as a mini-mum of 18-24 months, before a significant improvement is observed.

Authors of the current paper propose that oral alendronate is an effective alternative to intravenous pamidronate in treating patients with PFD. However, they have not mentioned about the only paper comparing intravenous and oral bisphosphonates in PFD(2). In the above-mentioned article, no differences were found in the favorable response to either oral bisphosphonates alone or in combination with intravenous therapy regarding bone pain and fracture healing. Therefore, lower cost and ease of administration are not the only reasons favoring the use of oral over intravenous bisphosphonates, but there are published reports too.

Concern has been raised regarding the safety profile of bisphosphonates in children as most of the experience has been obtained from their use in osteoporosis and Paget’s disease that predominantly occur in adults. However, no serious side effects were noted in a recent study(3) conducted on 18 children and adolescents using pamidronate treatment for 1.2-9.1 years (median 3.8 years).

In conclusion, bisphosphonates are safe and effective in reducing bone pain and incidence of fractures in children with PFD. Oral alendronate is an effective alternative to intravenous pamidronate in this setting.

Kumar S.,
Neurology Unit,
Department of Neurological Sciences,
Christian Medical College Hospital,
Vellore, Tamilnadu 632 004, India.
E-mail: [email protected]