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Treatment with cyclical intravenous pamidronate (IVP) improves clinical course in
children with chronic recurrent multifocal osteomyelitis (CRMO), but theoretically
might affect longitudinal growth. In this study we analyzed growth during IVP treatment
in ten CRMO patients.
10 patients (5 M, 5 F) were enrolled, with mean (range) age 11.4 (4.5–16.3) years
at IVP treatment. All patients received a 3-day infusion of IVP (0.5 mg/kg/day for
the first dose; 1 mg/kg/day subsequently), followed by 1-day infusion monthly or 3-day
infusion every 3 months until resolution of MRI documented bone inflammation. Weight
and height were measured prior to first IVP, at 1-year, and at final follow-up, and
results were transformed into age- and gender-matched z-scores. Hotelling's test on
the bivariate height and weight differences between 2 time points was performed.
Patients received a mean (range) 6.23 (2.5–11.5) mg/kg/year of IVP to achieve resolution
of MRI documented inflammation. Follow-up was a mean (range) 27.4 (16–46) months.
At baseline, 4/10 children had low baseline height z-scores (z < -1.0), compared to
1/10 at final follow-up. At one year, height and weight z-scores jointly had increased
significantly (p = 0.014). Univariate point estimates and 95% confidence intervals
(95% CI) for average differences post-pre were height = 0.192, (95% CI-0.16, 0.54),
and weight = 0.574, (95% CI 0.10, 1.04).
At 1-year following first pamidronate treatment, age-and gender-specific height and
weight z-scores remained similar or increased, suggesting that 1. Pamidronate in pediatric
CRMO does not have a detrimental effect on longitudinal growth
"Catch-up growth" can occur in this selected population.