Bone Health in Children and Adolescents With Chronic Diseases That May Affect the Skeleton: The 2013 ISCD Pediatric Official Positions

Bianchi, Maria Luisa; Leonard, Mary B.; Bechtold, Susanne; Högler, Wolfgang; Mughal, M. Zulf; Schönau, Eckhart; Sylvester, Francisco; Vogiatzi, Maria; Heuvel‐Eibrink, Marry M. van den; Ward, Leanne M.

doi:10.1016/j.jocd.2014.01.005

Cited by 116 publications

(104 citation statements)

References 135 publications

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“…BMAD is the most accurate method to predict VFs (14). Despite its pitfalls, DXA is recommended as a monitoring tool in children with chronic disease, who are at a risk of developing osteoporosis and those who are already on treatment to guide future management (15). An alternate technique used in children with spinal deformity or contractures is the lateral femur DXA scan (16).…”

Section: Assessment Of Bone Mass and Structurementioning

confidence: 99%

ENDOCRINOLOGY AND ADOLESCENCE: Osteoporosis in children: diagnosis and management

Saraff

Högler

2015

European Journal of Endocrinology

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Osteoporosis in children can be primary or secondary due to chronic disease. Awareness among paediatricians is vital to identify patients at risk of developing osteoporosis. Previous fractures and backaches are clinical predictors, and low cortical thickness and low bone density are radiological predictors of fractures. Osteogenesis Imperfecta (OI) is a rare disease and should be managed in tertiary paediatric units with the necessary multidisciplinary expertise. Modern OI management focuses on functional outcomes rather than just improving bone mineral density. While therapy for OI has improved tremendously over the last few decades, this chronic genetic condition has some unpreventable, poorly treatable and disabling complications. In children at risk of secondary osteoporosis, a high degree of suspicion needs to be exercised. In affected children, further weakening of bone should be avoided by minimising exposure to osteotoxic medication and optimising nutrition including calcium and vitamin D. Early intervention is paramount. However, it is important to identify patient groups in whom spontaneous vertebral reshaping and resolution of symptoms occur to avoid unnecessary treatment. Bisphosphonate therapy remains the pharmacological treatment of choice in both primary and secondary osteoporosis in children, despite limited evidence for its use in the latter. The duration and intensity of treatment remain a concern for longterm safety. Various new potent antiresorptive agents are being studied, but more urgently required are studies using anabolic medications that stimulate bone formation. More research is required to bridge the gaps in the evidence for management of paediatric osteoporosis.

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Section: Assessment Of Bone Mass and Structurementioning

confidence: 99%

ENDOCRINOLOGY AND ADOLESCENCE: Osteoporosis in children: diagnosis and management

Saraff

Högler

2015

European Journal of Endocrinology

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“…The first important concern is the requirement of adjusting DXA output in survivors of ALL, with a body size (weight and/or height) correction which derived BMC for bone area. After the correction many patients previously considered with low BMD Z scores are in fact at normal limits [12,[24][25][26][27][28][32][33][34][35][36][37]. Secondly, it is important to establish local norms with DXA and not rely on the ranges provided by the manufacturers of densitometers [35,38].…”

Section: Assessment and Interpretation Of Bone Mineral Density In Youmentioning

confidence: 99%

Are Survivors of Childhood Acute Lymphoblastic Leukemia at Increased Risk for Low Bone Mass?

Siviero-Miachon¹,

Lee²,

Guerra‐Júnior

et al. 2014

J Leuk

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Acute lymphoblastic leukemia is the most prevalent cancer in children. As an increasing number of cancer survivors reaches adulthood, there may be consequences of the treatment, and there is an issue if low bone mass might be included as a significant late effect. Acute lymphoblastic leukemia patients may have their bone mass compromised during therapy and many years after its withdrawal, but the degree of bone mass decline or recovery are not well elucidated to date. Survivors of stem cell transplantation for leukemia have additional risk factors for bone loss and should be evaluated with caution. Our target is to make a warning about the difficulties in assessing and interpreting bone mass in children and adolescents, the limitations in this assessment in acute lymphoblastic leukemia young survivors (including survivors of stem cell transplantation), the possibility of misdiagnoses, the reasons (if there are any) of low bone mass in this particular group of cancer survivors, as well as consider the therapeutic issues available.

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“…Neuromuscular and neurodevelopmental disorders in children interfere with the normal physical activity and nutrition, and rendering it is completely impossible; the progressive nature of these disorders may lead to low bone mass and/or osteoporosis [1] [2]. The group at a particularly high risk of bone mineral loss includes children with cerebral palsy and muscular dystrophy and patients with motor activity restrictions secondary to permanent or progressive destruction of the locomotor system [3].…”

Section: Introductionmentioning

confidence: 99%

“…The group at a particularly high risk of bone mineral loss includes children with cerebral palsy and muscular dystrophy and patients with motor activity restrictions secondary to permanent or progressive destruction of the locomotor system [3]. In all the paediatric chronic diseases which may affect the skeletal system, densitometric assessment of the bone is indicated [1]. This also applies to diseases which lead to motor disability.…”

Section: Introductionmentioning

confidence: 99%

Bone Mineral Density and Vitamin D Status in Children with Chronic Neurological Syndromes—Clinical Observations

Jakubowska-Pietkiewicz¹,

Orzechowska²,

Woźniak³

et al. 2018

CRCM

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Background: Some of the risk factors for osteoporosis population include: chronic immobilisation, insufficient dietary supply of calcium and vitamin D, decreased physical activity and long-term pharmacological treatment (glucocorticoids, anticonvulsant drugs). In disabled children and adolescents, the negative impact of these factors may cumulate to considerably impair the quality of life. Objectives: The aim of our study was to assess the vitamin D status and bone mineral density in children with chronic neurological syndromes. Material and Methods: A total of 34 children between 3 and 18 years of age were examined: 9 children with muscular dystrophy, 17 with cerebral palsy and 8 with lumbar myelomeningocele. All the subjects underwent the following assessments: measurement of the concentration of the hepatic metabolite of vitamin D and total body less head and/or lumbar spine densitometry by dual energy X-ray absorptiometry (DEXA). Low bone mass or low bone mineral density was diagnosed if the Z-score value was found to be equal to or below −2.0. Results: Indications for the above tests were chronic immobilisation or motor activity restriction, and-in 10/34 children-femoral or vertebral fracture. Vitamin D deficiency (<30 ng/ml) was detected in 27/33 patients (>81%). Low bone mass on densitometry was demonstrated in 27/34 and osteoporosis in 10/34 subjects (Z-score ≤ −2.0). Conclusion: Bone densitometry should be included in the standard of care for children with chronic neurological syndromes, and early detection of low bone mass should be an indication for treatment with calcium and vitamin D.

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Bone Health in Children and Adolescents With Chronic Diseases That May Affect the Skeleton: The 2013 ISCD Pediatric Official Positions

Cited by 116 publications

References 135 publications

ENDOCRINOLOGY AND ADOLESCENCE: Osteoporosis in children: diagnosis and management

ENDOCRINOLOGY AND ADOLESCENCE: Osteoporosis in children: diagnosis and management

Are Survivors of Childhood Acute Lymphoblastic Leukemia at Increased Risk for Low Bone Mass?

Bone Mineral Density and Vitamin D Status in Children with Chronic Neurological Syndromes—Clinical Observations

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