Bisphosphonate-Induced Osteopetrosis

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Abstract
Bisphosphonates, synthetic analogues of inorganic pyrophosphate, potently inhibit skeletal resorption by suppressing the recruitment and activity of osteoclasts and shortening their life span.1 Consequently, several bisphosphonates were developed to treat hypercalcemia (associated with cancer), osteoporosis, and Paget's disease of bone and are used for additional disorders in adults.1 Increasingly, bisphosphonates are being administered to children2-4 and have been reported to improve clinical outcomes and augment bone mass in conditions such as osteogenesis imperfecta,5 juvenile osteoporosis,2 and fibrous dysplasia,6 although controlled studies of these compounds in children are lacking.3,4,7 Genetic defects that abrogate the action of osteoclasts cause osteopetrosis, which is characterized by dense, poorly formed, and brittle skeletal tissue.8 Acquired osteopetrosis, or marble bone disease, could therefore result from treatment with bisphosphonates during growth. Here, we document a case of drug-induced osteopetrosis.