Oral bisphosphonate treatment

It has been suggested to you that your child may benefit from treatment with oral bisphosphonates. This information leaflet is intended to answer some of the questions that you may have.

Why does my child need treatment?

When we saw your child in clinic their medical and fracture history was recorded and your child was examined. A bone density scan (DXA) and spine X-rays are likely to have been done and any results discussed with you.

The consultant has recommended your child for treatment with risedronate which is one of a group of medications known as bisphosphonates.

It might be the case that your child has already had intravenous bisphosphonate treatment and they are changing onto oral treatment.

What are bisphosphonates?

Bisphosphonates are a group of medicines, which are similar to substances that are found naturally in the human body.

How do they work?

The 2 main groups of cells within the bone are called:

• osteoblasts – that make bone
• osteoclasts – that break down the bone

Bone cells are constantly renewing. Firstly, osteoclasts remove bone, and then osteoblasts make new bone in the same place. In children, bone is made at the end of long bones, around the building blocks in the spine (vertebrae), and on the outside of bones that are growing. Bisphosphonate medication works by preventing the old bone from being removed by osteoclasts, but still allows new bone formation by osteoblasts to continue. This increases the density and strength of the bone.

What are the benefits of having this treatment?

Studies have shown that bone becomes denser, wider and stronger than before treatment. For many children the risk of fracture is reduced. Treatment can also reduce the amount of bone pain that children have.

What are the side effects of treatment?

Children who are prescribed risedronate may experience tummy ache or nausea (feeling sick) when they first take risedronate. The nurse specialists will give you instructions on how to take this medication to help reduce this.

Please also see the information leaflet provided with the medication for a list of possible side effects. Following the guidelines below will help reduce these side effects.

How is the treatment given?

Risedronate is taken by mouth usually once a week or once a fortnight. It needs to be taken on an empty stomach to make sure that it is properly absorbed.

For this reason we suggest that it is taken first thing in the morning before breakfast. It should be taken with a large glass of tap water and your child should not have anything else to eat or drink (except tap water) for at least 30 mins afterwards. It is possible to crush the tablet and mix it with a small amount of water. Your child will need to remain upright (sitting or standing) for 30 mins afterwards. They may move around during this time but should not lie down. Following this time they may eat and drink normally and take other medications, if required.

It is important for children with bone problems to have a good intake of calcium rich foods in their diet. They should also take daily vitamin D (or a multivitamin), which can be bought from a supermarket or pharmacy.

How will my child be monitored?

Your child will be seen in an outpatient clinic appointment around every 6 to 12 months. Bone density X-rays called ‘DEXA’ scans will be used to assess their response to treatment and to look for any changes in the shape and size of the vertebrae. We may also performe spine and skull X-rays if needed.

Blood tests will be taken once a year. This will be done after the clinic appointment.

Urine samples are used to monitor bone turnover. You should collect a urine sample the day before your child starts taking risedronate, and also before each clinic appointment. This should be a ‘second void urine’ which means the sample should be collected the second time the child does a pee that day. Your clinical nurse specialist will discuss this further with you in the clinic appointment. Please remember to bring the urine samples to your next appointment.