BRIEF REPORT Efficacy of intravenous alendronate for the treatment of glucocorticoid-induced osteoporosis in children with autoimmune diseases Yuzaburo Inoue & Naoki Shimojo & Shuichi Suzuki & Takayasu Arima & Minako Tomiita & Masanori Minagawa & Yoichi Kohno Received: 21 December 2007 / Revised: 6 February 2008 / Accepted: 12 February 2008 / Published online: 11 March 2008 # Clinical Rheumatology 2008 Abstract Our objective was to investigate the efficacy of intravenous alendronate for the treatment of glucocorticoid- induced osteoporosis (GIOP) in children with autoimmune diseases. Five children with autoimmune disease and GIOP were treated with 5 mg intravenous alendronate once every 3 months. After 1 and 2 years, we evaluated the changes in the Z score of the femoral neck bone mineral density (BMD), serum bone alkaline phosphatase, and urinary deoxypyridinoline. Six patients with GIOP, whose BMD could be observed over a 1-year period without alendronate treatment, were defined as controls. After 1 and 2 years of treatment, intravenous treatment significantly inhibited bone loss. The efficacy of alendronate demonstrated a significant correlation with a high level of bone turnover markers before alendronate treatment. Intravenous alendro- nate is considered to be a good choice for the treatment of GIOP because of its excellent efficacy. In addition, our study suggests that the efficacy of alendronate depends on the bone turnover of patients before treatment. Intervention with bisphosphonates during periods of high bone turnover may be recommended. Keywords Alendronate . Glucocorticoids . Osteoporosis . Pediatric rheumatic diseases Introduction Glucocorticoid-induced osteoporosis (GIOP) is one of the most common and serious adverse effects of glucocorticoid treatment in children with autoimmune diseases [1–3]. Glucocorticoid treatment mainly suppresses bone formation despite continued bone resorption, resulting in bone loss [4]. Even if bone loss is small, the decrease in the Z score of bone mineral density (BMD) is large because bone mass increases during childhood in healthy children [5]. More- over, patients, whose bone mass does not reach peak bone mass during childhood due to GIOP, are at permanent risk of suffering fractures [5]. Up to now, there has been no standard approach to the management and treatment of GIOP in children, although guidelines for the treatment of GIOP in adults have been published in many countries. Based on these guidelines, bisphosphonates are recommended as first-line drugs for all patients who have undergone long-term treatment with glucocorticoids [6–8]. Bisphosphonates are synthetic deriv- atives of pyrophosphonates, which inhibit bone resorption due to their action on osteoclasts [9] and also increase BMD. Although some previous studies have shown a significant efficacy of bisphosphonates for the treatment of childhood GIOP [10, 11], they are still not normally administered to children. As a result, guidelines for the appropriate usage and administration of bisphosphonates for children with GIOP remain unclear. It had been reported that patients who take oral bisphosphonates show poor compliance because of a rather complicated treatment regimen [12, 13]. The intravenous administration of several bisphosphonates that are usually given orally has been reported to increase BMD in postmenopausal osteoporosis [14–16]. Therefore, we hy- Clin Rheumatol (2008) 27:909–912 DOI 10.1007/s10067-008-0864-6 Y. Inoue (*) : N. Shimojo : S. Suzuki : T. Arima : M. Tomiita : M. Minagawa : Y. Kohno Department of Pediatrics, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuou-ku, Chiba City, Chiba, Japan e-mail: yuzaburo@cf6.so-net.ne.jp