Bisphosphonate use in children with cerebral palsy

This new review assessed the efficacy and safety of bisphosphonate therapy in the treatment of low bone mineral density (BMD) or secondary osteoporosis (or both) in children with cerebral palsy (CP), GMFCS (Gross Motor Function Classification System) Levels III to V, who are under 18 years of age.

The review authors included two studies involving 34 participants with CP of similar levels of severity: one study compared bisphosphonates with placebo; the other compared bisphosphonates plus alfacalcidol with alfacalcidol alone. Both studies were conducted in hospital settings; one in Japan and one in the USA. One study did not report its funding sources, while the other was supported by research academic and hospital foundations, with the pharmaceutical companies donating components of the calcium and vitamin supplements.


The review authors found very low certainty evidence that, compared with placebo or no treatment, bisphosphonate treatment for at least six months may improve BMD in the lumbar spine and distal femur in children with CP and low BMD or osteoporosis. However, they found inconclusive evidence of the effects of bisphosphonate treatment on blood markers of bone strength; one study found that bisphosphonates reduce serum N-telopeptides (NTX) more than placebo, while another found that both bisphosphonate plus alfacalcidol and alfacalcidol alone reduced NTX but did not compare groups.

Neither study reported any serious adverse outcomes following 12 months of treatment, and neither study reported data on changes in volumetric BMD in the distal radius or tibia, or changes in fracture frequency.

The evidence is current to September 2020.


The review authors concluded that, given the limited data available (two studies conducted over 10 years ago with only 34 participants), there is very low certainty evidence that bisphosphonates may improve bone health in children with CP, compared with placebo or no treatment. Further studies are needed to assess the effects of bisphosphonates in children with CP, including studies examining the effects of bisphosphonates combined with other treatments.

Read the full review here on the Cochrane Library.