[PedOncoDoc]

Originally Posted by kachingchingpow

Thanks Boomer. Duke *is* where they propose sending him for the free fibular graft. His ortho is preparing a packet to send to them for consideration. Evidently the candidate has to be ideal in order to proceed. In the mean time, there is a medicine that I can't recall the name of that they would like to put him on. Evidently it's similiar to what is prescribed to patients with osteoporosis. It has shown some promise in the area of controlling the breakdown.

Thanks for everyone's thoughts and prayers.

Best of luck on the surgical assessment at Duke - they do a lot of good/novel things there.

I believe medication they are recommending is a bisphosphonate - these medications were designed to combat osteoporosis but have been found to have benefit for patients with decreased bone mineral density - we tend to use these medications in some of the children we treat who are expected to have long-term steroid medication use.

There are several different medications in this class on the market, all have a drug name ending in "dronate" or "dronic acid". You may have seen advertisements for Boniva, Zometa, Fosamax or Aredia - all members of this class of drugs - on television.

There are a few studies that discuss bisphosphonate treatment for AVN in pediatrics that I could find while reveiwing the scientific/medical lioterature. There are a few out of the UK and Australia that I focused on. It looks like there is less progression of femoral head collapse (breadkdown of the ball of the thigh bone), improvement of pain and function for most patients (up to 77%). There have not been any large-scale randomized controlled trials (considered the best way of evaluating the efficacy of a treatment when compared to current standard of care) that I could find, but the few studies reported are definitely promising.

HTH.