Bone Abstracts

Intravenous (IV) Pamidronate (PAM) has been used in the treatment of Osteogenesis Imperfecta (OI) and is known to increase bone mineral density (BMD) and reduce the incidence of fractures. However an attractive alternative is the more potent IV Zoledronic acid (ZOL).

Objectives: To determine the clinical efficacy of IV PAM vs ZOL in children with mild to moderate OI and compare the cost benefits of the two drugs.

Methods: A retrospective review of patients aged ⩾5 years with type I or IV OI, who started either PAM or ZOL (2001–2014) at a tertiary centre was conducted. PAM was administered in cycles of 1.5 mg/kg per day over 2 days every 3 months and ZOL as a single dose of 0.05 mg/kg 6 monthly. Lumbar Spine (LS) DXA was performed pre and 1 year post treatment. Cost analysis was performed for a 5 years period based on drug cost, nursing and medical time, equipment and days in hospital per year (8 vs 2 days per year, for PAM vs ZOL).

Results: A total of 40 patients were identified, 20 in each group. LS BMAD z-scores increased significantly in both groups (P<0.001). The median (interquartile range) increase in LS BMAD z-score for the PAM group (1.67 (1.46–2.21)) and the ZOL group (1.75 (1.46–2.00)) was not significantly different. Total cost per treatment cycle per patient was £498 for ZOL and £1157 for PAM. Annual costs for bisphosphonate therapy (BP) decreased since introduction of ZOL (see Figure 1).

Conclusion: ZOL is a significantly cheaper alternative to PAM with comparable efficacy, resulting in substantial annual savings for health care providers. ZOL is also a more convenient option for patients due to fewer hospital visits.

Disclosure: The authors declared no competing interests.

Figure 1