[Treatment of post menopausal osteoporosis with intravenous pamidronate in patients with esophagogastric pathology].

Pamidronate is an effective inhibitor of bone resorption; for this reason it is used in the treatment of high bone turnover diseases and osteoporosis. Because of potential gastric and esophagic side effects their oral use is limited in patients with active pathology in these organs. With the aim to evaluate the usefulness and to establish the ideal schedule of treatment of intravenous pamidronate, we assayed pamidronate infusions (APDIV) in 20 postmenopausal women with active gastroesophagical diseases. Ten of these patients received 30 or 45 mg weekly until they achieved an average dose of 157.50 +/- 9.28 mg/year in one month (range: 120-180 mg) (Group A). Another comparable ten women's group received 30 or 45 mg every three months or 90 mg every six months; the achieved average dose in this group was 166.50 +/- 6.87 mg/year (range: 120-180 mg) (Group B). All patients received 1,000 mg elemental calcium daily. Bone mineral density in lumbar spine significantly increased in both groups, but this increment (delta DMO%) was higher in group B. Bone mineral density in femoral neck was only increased in group A. Parathyroid hormone (iPTH) significantly increased at the third month but returned to basal values at the end of the year in both groups. Parameters of bone remodeling such as osteocalcin (BGP), pyridinoline and deoxipyridinolin decreased progressively and remained low at the end of the year. The treatment was well tolerated: only two patients in group A and one in Group B experienced fever and pseudoflu syndrome; phlebitis was present in one patient in the second group. In conclusion, intravenous Pamidronate is an effective and safe treatment for postmenopausal osteoporosis specially in these patients with esophagicor gastric disorders. Future trials are needed to clarify the ideal dose and schedule of treatment.