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Lower incidence of fracture after IV bisphosphonates in girls with Rett syndrome and severe bone fragility

Journal title
PloS one
Publication year
Lambert, A. S.; Rothenbuhler, A.; Charles, P.; Brailly-Tabard, S.; Trabado, S.; Celestin, E.; Durand, E.; Fontaine, I.; Miladi, L.; Wicart, P.; Bahi-Buisson, N.; Linglart, A.

BACKGROUND: Classic Rett Syndrome (RS) is a disabling condition mainly caused by MECP2 mutations. Girls with RS are at risk of developing bone fragility and fractures at a young age which results in pain and may seriously impair quality of life. OBJECTIVE: To retrospectively assess the safety and efficacy of IV bisphosphonates on fracture, bone mineral density (BMD) and bone markers in RS girls with bone fragility. METHODS: RS girls received either IV pamidronate (n = 19) or IV zoledronate (n = 1) for 2 years. RESULTS: Of 20 patients studied (age: 12.5 years [6; 39]), 14 were non-ambulatory. The incidence of fracture decreased from 37 fractures in 20 patients, to 1 fracture during or after treatment (follow-up: 3.1 years [1.5; 5]). The spine BMD Z-score improved from -3.2 [-5.6; -0.1] to -2.2 [-3.8; 0.0], p = 0.0006. Most parents reported decreases in chronic pain and 2 patients started to walk. Urinary calcium excretion decreased from 0.7 [0.18; 1.5] to 0.2 [0.03; 0.67] mM/mM of creatinine (p = 0.0001). Pamidronate was well tolerated. CONCLUSION: RS girls should be screened for impaired bone mineralization and preventive measures should be taken. In girls experiencing fractures, IV bisphosphonates constitute a beneficial adjuvant treatment to diminish the risk of fracture and restore bone density.

Research abstracts