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Thus, bisphosphonates given around the time of frac-
ture or surgery will be found in heavy concentration in
healing callus.
To prevent the deposition of bisphosphonates in high
concentrations at the site of surgery where they will then
persist for many years, some authors recommend that
administration of bisphosphonates be delayed until a
few months after surgery, when the stage of formation
of the soft and hard callus is complete. Also, bisphos-
phonates are now often given sequentially at regular
intervals for an extended period of time over the life of a
growing child, starting in infancy and ending at matura-
tion of the skeleton. With so much opportunity for drug
treatment, the ability to stop treatment prior to surgical
intervention and allow recovery of osteoclastic activity
in advance of need in the healing process seems a rea-
sonable idea. How much time should elapse between
surgery/osteotomy and resumption of bisphosphonate
administration is only a reasonable guess with little data
available at this time to allow specific recommendations.
After osteotomy, delaying administration of bisphos-
phonates until there is radiographic evidence of callus at
the osteotomy site is a reasonable rule of thumb, as the
formation of callus will have already occurred. With the
current strategy of combined medical and surgical inter-
vention in OI, studies designed to examine maximization
of both treatment limbs will be needed to further direct
endocrinologists and orthopedists in the treatment of
these complex patients.
[10]
[11]
[12]
[13]
[14]
[15]
[16]
[17]
References
[2] Frick SL, Larson T EP, Brighton B. High reoperation rate and failed
expansion in lower extremity rods in osteogenesis imperfecta.
Pediatric Orthopaedic Society of North America Annual Meeting;
2010; Hawaii.
[18]
[19]
[20]
[21]
[22]
[23]
