Acute Phase Reaction After First Neridronate Infusion in Children with Osteogenesis Imperfecta: An Analysis Based on Questionnaire Data from 65 Patients

BACKGROUND: Bisphosphonates represent the current standard of care for the pharmacological treatment of pediatric patients with osteogenesis imperfecta (OI). However, data on acute phase reactions (APRs) after first-time administration, especially with neridronate, remain limited. OBJECTIVE: This study evaluates the incidence, characteristics, and severity of APRs following the initial intravenous neridronate infusion in pediatric OI patients. METHODS: Sixty-five bisphosphonate-naïve children with genetically or clinically confirmed OI received weight-adjusted intravenous neridronate during a brief hospitalization. Parents documented side effects, including fever onset/duration and skeletal pain, using standardized questionnaires. RESULTS: Neridronate was generally well tolerated. No severe adverse events occurred. Forty percent of patients developed transient fever. Fever typically emerged within 12-24 h and resolved within 1-2 days. New skeletal pain was reported in 40% of patients, with 60% experiencing severe pain. Mean skeletal pain scores decreased below baseline within 4 days post-infusion. Fever duration did not differ significantly between OI types. CONCLUSIONS: Fever and skeletal pain are common yet self-limiting side effects after first neridronate infusion in children with OI. Adequate pain medication and caregiver education are important to improve treatment adherence and patient comfort during initiation of bisphosphonate therapy.