Bone Abstracts

Objectives: The primary objective of this project was to determine the nature and timing of perceived early adverse effects associated with bisphosphonate therapy. Additional information was sought on how this affected the child and family, to determine if changes should be made to local guidelines.

Methods: A Smartphone-based text message survey was sent to parents of patients receiving intravenous bisphosphonate therapy for primary and secondary osteoporosis. Patients in our unit were routinely admitted for 24 hours for their first infusion, but not subsequent ones. The survey was designed to assess the nature, severity and impact of adverse effects at three defined timepoints: the day of, three days after, and five days after bisphosphonate administration. Surveys were received by text message with a link to the online questionnaire.

Results: The day one response rate was 90% from twenty surveys. Day three and five response rates were 80% and 65% respectively. The majority of adverse effects occurred more than 24 hours after bisphosphonate administration. On day one, 16% of children reported being unwell immediately following infusion. 62% of respondents to the day three survey reported being unwell on day two or three following treatment. The highest frequency of adverse events was reported on the day five survey, with 69% of patients reporting adverse effects on days four or five. The most commonly reported symptom was fever (50%), with generalised pains and lethargy also commonly mentioned. >90% who experienced adverse effects required time off school and >60% visited hospital for further assessment and treatment.

Conclusion: This novel text-based survey had a good response rate and highlights the known adverse effects associated with bisphosphonate therapy. Valuable information about timing of symptoms has stimulated two main changes in clinical practice locally:

1. Patients are no longer admitted for their first bisphosphonate infusion, as the majority of adverse effects did not occur in the first 24 hours after administration.

2. Parents are given more detailed information about what to expect with regard to potential adverse effects and subsequent management, to reduce associated hospital visits and disruption to daily routines.

Disclosure: The authors declared no competing interests.