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Table 3 Example of intravenous bisphosphonate regimens used for the management of bone pain in patients with fibrous dysplasia / McCune Albright Syndrome

From: Best practice management guidelines for fibrous dysplasia/McCune-Albright syndrome: a consensus statement from the FD/MAS international consortium

 Pamidronate Zoledronate 
Loading DoseStop ifCommentsLoading DoseStop ifComments
Paediatrica1 mg/kg × 2 on consecutive days up to a total of 90 mg. If no response, consider repeat at week 8.No response after 2 cyclesConsider use of 20–30 ng/kg/day calcitriol or 30–50 ng/kg/day alfacalcidol up to 1 mcg/day and calcium supplements for 4 days after first injection to maintain calcium homeostasis especially in those with high disease burden.0.025 mg/kg. If no response, 0.025 mg/kg at week 8. If still no response, 0.05 mg/kg at week 24No response after 3 dosesConsider use of 20–30 ng/kg/day calcitriol or 30–50 ng/kg/day alfacalcidol up to 1 mcg/day and calcium supplements for 4 days after first injection to maintain calcium homeostasis especially in those with high disease burden
Adult90 mg ×2 consecutive days every 6 monthsNo response after 2 cycles Up to 5 mg monthly (switch to maintenance dose when achieve response)No improvement in pain after 3 doses 
  1. Legend: a Dosing examples are intended for children age 3 and above. If pain management is needed for a child under age 3, recommend consulting with a paediatric metabolic bone specialist. bMonthly zoledronate is usually reserved for severe cases with a very high skeletal burden. Most cases require annual or bi-annual therapy