Taner ÖZGÜR, Erdal EREN, Halil SAĞLAM, Ömer TARIM, Esra DENİZ, Ali ÖZBOYACI, Papatya ÇAKIR, Evren ÖZBOYACI

sekonder osteoporozlu çocuklarda alendronat tedavisinin etkinliği

Giriş: Daha çok erişkinlerin hastalığı olarak bilinen osteoporoz çocuklarda kronik hastalıklara bağlı olarak karşımıza çıkmaktadır. Tedavide bifosfonatlar güvenli olarak kullanılmakta olup yararları kanıtlanmıştır. Alendronat oral kullanım avantajı nedeniyle daha çok tercih edilmektedir. Burada kliniğimizde izlenen sekonder osteoporozlu hastalarda alendronatın etkinliği değerlendirilmiştir. Gereç ve Yöntem: Sekonder osteoporozlu toplam 46 hasta [28 erkek (%60,9), 18 kız (%39,1)] çalışmaya dahil edildi. Alendronat oral olarak günlük doz 30 kg için 10 mg verildi. Kemik mineral yoğunluğu (KMY) DEXA ile değerlendirildi. Bazal DEXA çekiminden sonra, tedavinin etkinliği açısından 6. ay, 12. ay ve 24. ay tekrar DEXA çekimi yapıldı. Bulgular: Ortalama boy, kilo ve vücut kitle indeksi standart deviasyon skoru (SDS) sırasıyla -2,43, -2,82 ve -1,72 idi. Serum Ca, P ve ALP değerleri normaldi. Tedavinin başındaki ortalama KMY SDS -4,03±0,96 iken 6. ay, 12. ay ve 24. ayda DEXA Z skorları sırayla -3,51±1,02, -2,82±1,09 ve -2,43±0,93 idi. KMY Z-skorlarında 6’ıncı, 12’inci ve 24’üncü aylarda bazale göre elde edilen artışlar istatistiksel olarak anlamlı idi. Sonuç: Oral bifosfonat tedavisinin kullanımı parenteral tedaviye göre daha konforlu ve daha ucuzdur. Sonuçlarımız; oral alendronat tedavisinin erişkinlerde olduğu gibi çocuklardaki sekonder osteoporoz tedavisinde de güvenle kullanılabileceğini, KMY’de belirgin düzelme sağladığını, hastalar tarafından iyi tolere edilebilen bir tedavi yöntemi olduğunu göstermektedir. Çocuklarda da birçok çalışma olmasına rağmen osteoporozun çocuklardaki tedavisinde ilacın yaş, doz ve süresi konusunda uzlaşı yoktur.

The efficacy of alendronate in children with secondary osteoporosis

Introduction: Osteoporosis which is primarily known as an adult disease may be encountered secondarily due to chronic diseases in children. Biphosphonates can be safely used in treatment with proven benefits. Alendronate is often preferred because of its advantage of oral use. Here, the efficiency and safety of alendronate in children with secondary osteoporosis were evaluated. Materials and Method: A total of 46 children (28 boys; 60.9% and 18 girls; 39.1%) with secondary osteoporosis were included. Alendronate was given orally at a dose of 5 mg once daily for children less than 30 kg and 10 mg once daily for those weighing 30 kg or more. Bone mineral density (BMD) was evaluated with DEXA taken at baseline, at 6th month, at 12th month and at 24th month. Results: Mean standard deviation scores (SDS) of height, weight and body mass index were -2.43, -2.82 and -1.72, respectively. Serum Ca, P and ALP levels were all normal. Mean BMD SDS at baseline, 6th month, 12th month and 24th month were -4.03±0.96 -3.51±1.02, -2.82±1.09 and -2.43±0.93, respectively. Improvements in BMD z-scores at 6th, 12th and 24th months compared to baseline were all statistically significant. Conclusion: Our results showed that oral alendronate treatment which is more comfortable and cheaper than parenteral ones results in significant improvements in BMD, can be safely used and easily tolerated in children with secondary osteoporosis, as in adults. Though a plenty of studies were performed in children, there is still no consensus on the preferred and safe dose of the drug and the duration of treatment, as well as from the beginning of what age can the drug be introduced to the children requiring osteoporosis treatment.

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