Anabolic Therapy for the Treatment of Osteoporosis in Childhood

Abstract

While growth hormone and androgens appears to be relatively weak anabolic modulators of bone mass, emerging therapies targeting bone formation pathways (anti-transforming growth factor beta antibody and anti-sclerostin antibody) hold considerable promise. Teriparatide remains an attractive option that merits formal study for patients post-epiphyseal fusion, although it must be considered that adult studies have shown its effect is blunted when administered following bisphosphonate therapy. Mechanical stimulation of bone through whole body vibration therapy appears to be much less effective than bisphosphonate therapy for treating osteoporosis in children. New anabolic therapies which target important pathways in skeletal metabolism merit further study in children, including their effects on fracture risk reduction and after treatment discontinuation.

Bone health in childhood cancer: review of the literature and recommendations for the management of bone health in childhood cancer survivors

“…However, in childhood, GH seems to be relatively weak as a bone-targeted anabolic treatment outside of the GHD setting. Therefore, considering the burden to children of multiple injections, the potential side-effects, and uncertainties about the longer-term safety, the benefits to prevent or treat osteoporosis outside of hormone replacement therapy for GHD do not justify its risks and costs [12,112]. In adulthood, GHD may be associated with a decreased BMD, and BMC with an increased fracture risk.…”

“…The effect of testosterone replacement therapy on bone health in boys with delayed puberty has not been described. There are only a few studies conducted on adult male subjects that have shown the benefits of testosterone as replacement treatment [112]. Among male CCSs, limited data exist on the influence of androgen insufficiency on BMD (grade of evidence: very low) [11].…”

Osteoclasts protect bone blood vessels against senescence through the angiogenin/plexin-B2 axis

“…Impaired acquisition of peak bone mass or loss of bone mass during childhood has lifelong implications, including greater fracture risk throughout adulthood [14][15][16] . There are still no ideal medications to treat osteoporosis in children 17 . The mechanisms by which GCs suppress the acquisition of bone mass need to be further elucidated.…”

Does Whole-Body Vibration Treatment Make Children’s Bones Stronger?

“…WBV has, therefore, received increasing attention as a treatment option including pediatric patient populations with individuals in the phase of bone acquisition. Young individuals with a broad variety of diseases which leads to poor bone health could be considered for WBV, hopefully without side effects, as a non-pharmacological anabolic approach to increase balance, neuromuscular function, and bone mass [ 13 ••]. The literature presents various WBV platforms with vibration strategies and as scientists should be able to reproduce the study and data, there was an early need for an international consensus on how to report data and how to describe the vibration intervention by the International Society of Musculoskeletal and Neuronal Interactions [ 14 ••].…”