ENDOCRINOLOGY AND ADOLESCENCE: Osteoporosis in children: diagnosis and management

Abstract

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.

Bone morbidity in pediatric acute lymphoblastic leukemia

“…6,8) BPs are synthetic analogues of pyrophosphate widely used in primary and secondary osteoporosis management. 70) BPs prevent osteoclastic bone resorption and relieve bone pain, while their use in prevention remains limited. 6) An Australian group recommends serum calcidiol level should be >50 nmol/L prior to the first BP infusion and maintained postinfusion.…”

Skeletal Fragility in Children with Chronic Disease

“…Lateral thoracolumbar X-ray is the most commonly employed method for detection of VF in children [37]. The Genant semi-quantitative method is a morphometric assessment of vertebrae used in adults and children with ≥20% loss in vertebral height ratio accepted as clinically significant [38].…”

Osteogenesis Imperfecta: New Perspectives From Clinical and Translational Research

“…Ensuring adequate vitamin D intake is often recommended, but how much vitamin D intake is needed in OI is not well‐established. A recent randomized controlled trial compared two doses of vitamin D supplementation, 400 IU and 2000 IU, in 60 children with OI, most of whom were vitamin D sufficient at baseline [mean serum 25(OH) vitamin D concentration: 67 nmol/L] .…”

“…(30,78,79) In more-severe OI, where long-bone deformities, scoliosis, and reduced mobility are major concerns, a multidisciplinary orthopedic and rehabilitation intervention program may be required. (80) Ensuring adequate vitamin D intake is often recommended, (81,82) but how much vitamin D intake is needed in OI is not well-established. A recent randomized controlled trial compared two doses of vitamin D supplementation, 400 IU and 2000 IU, in 60 children with OI, most of whom were vitamin D sufficient at baseline [mean serum 25(OH) vitamin D concentration: 67 nmol/L].…”