Managing pediatric osteoporosis

Cimaz, Rolando; Stagi, Stefano

doi:10.2217/ijr.13.47

Cited by 3 publications

(3 citation statements)

References 15 publications

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“…Children and adolescents need to achieve peak bone mass by age 18 years or enter adulthood with suboptimal bone mass and risk of osteoporosis as adults [ 42 ]. The inflammatory nature of PRDs may reduce the ability to achieve peak bone mass [ 43 ] due to the inflammation, pain, decreased activity, and other factors.…”

Section: Reviewmentioning

confidence: 99%

Vitamin D—update for the pediatric rheumatologists

Vojinović

Cimaz²

2015

Pediatr Rheumatol

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Vitamin D, upon its discovery one century ago, was classified as a vitamin. This classification still greatly affects our perception about its biological role. 1,25(OH)2D (now known as the D hormone) is a pleiotropic steroid hormone that has multiple biologic effects. It is integral to the regulation of calcium homeostasis and bone turnover as well as having anti-proliferative, pro-differentiation, anti-bacterial, immunomodulatory and anti-inflammatory properties within the body in various cells and tissues. Vitamin D (cholecalciferol) should be considered a nutritional substrate that must be ingested or synthesized in sufficient amounts for the further synthesis of the very important regulatory steroid hormone (D hormone), especially in patients with pediatric rheumatic diseases (PRD).Vitamin D insufficiency or deficiency was shown to be pandemic and associated with numerous chronic inflammatory and malignant diseases and even with increased risk of mortality. Several studies have demonstrated that a high percentage of children with pediatric rheumatic diseases (PRD-e.g., JIA, jSLE) have a vitamin D deficiency or insufficiency which might correlate with disease outcome and flares. Glucocorticoids used to treat disease may have a regulatory effect on vitamin D metabolism which can additionally aggravate bone turnover in PRD. An effort to define the optimal serum 25(OH)D concentrations for healthy children and adults was launched in 2010 but as of now there are no guidelines about supplementation in PRD.In this review we have tried to summarize the strong evidence now suggesting that as the knowledge of the optimal approach to diagnosis and treatment PRD has evolved, there is also an emerging need for vitamin D supplementation as an adjunct to regular disease treatment. So in accordance with new vitamin D recommendations, we recommend that a child with rheumatic disease, especially if treated with steroids, needs at least 2-3 time higher doses of vitamin D than the dose recommended for age (approximately 2000 UI/day). Vitamin D supplementation has become an appealing and important adjunct treatment option in PRD.

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Section: Reviewmentioning

confidence: 99%

Vitamin D—update for the pediatric rheumatologists

Vojinović

Cimaz²

2015

Pediatr Rheumatol

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“…hypophosphatasia, homocystinuria) and rare disorders of copper transport, including Wilson's disease and Menkes' kinky hair syndrome. Other uncommon causes of pediatric osteoporosis include idiopathic juvenile osteoporosis, featuring several fragility fractures during childhood that usually cease in adults, and early-onset of Paget disease; thus, secondary osteoporosis is more common in children due to chronic illness, medical treatment, neoplasia (7).…”

Section: Discussionmentioning

confidence: 99%

Association of COL1A1 SP1 and FOK-I VDR Genetic Polymorphisms in Young Male Idiopathic Osteoporosis

Man

Chiriac²,

Militaru

et al. 2017

Acta Endo (Buc)

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Introduction. Primary osteoporosis during childhood and adolescence represents an uncommon condition, and secondary forms are more likely to manifest at this age due to chronic disease and adverse effects of medical treatment. Case report. The authors report the case of a young male patient with a history of multiple idiopathic nonvertebral fragility fractures in addition to a family history of maternal osteoporosis and fracture, in whom osteoporosis was confirmed according to 2013 International Society for Clinical Densitometry (ISCD) criteria. Bone markers indicated low bone formation marker osteocalcin. Genetic testing revealed homozygosity for Sp1 COL1A1 gene polymorphism in combination to Fok-I vitamin D receptor (VDR) heterozygous polymorphism, to contribute to low bone mass and increased fracture risk. Severe premenopausal osteoporosis was present in the patient's mother, who was also tested positive for both gene polymorphisms. Conclusion. This case report highlights the association between COL1A1 and VDR candidate gene polymorphisms and fragility fractures in a family. Individual genetic testing might be of clinical value in idiopathic osteoporosis in young patients, identifying subjects at increased fracture risk.

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“…This approach consists of identifying those patients at risk of bone disease and counseling them about lifestyle and dietary calcium and vitamin D supplementations. Several studies suggest that physical activity in childhood is an effective strategy to achieve the optimal PBM 24) . Secondary osteoporosis is treated by removing the underlying specific cause.…”

Section: Therapeutical Approachesmentioning

confidence: 99%

Bone modeling, remodeling, and skeletal health in children and adolescents: mineral accrual, assessment and treatment

Maggioli

Stagi

2017

Ann Pediatr Endocrinol Metab

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The modeling and remodeling process of the bone is fundamental to maintaining its integrity and mechanical properties. Many physical and biochemical factors during childhood and adolescence are crucially important for the development of healthy bones. Systemic conditions, such as hormonal status, nutrition, physical inactivity, or many pharmacological treatments, as well as a local variation in the load, can influence bone turnover and, consequently, the attainment of a proper peak bone mass. However, many diseases affecting children and adolescents can be associated with a reduction in bone accrual or a loss of bone mass and quality, which leads to an increased risk of fracture over one's life. In this review, we examine the effects of genetics, physical activity, chronic diseases and pharmacological treatments, and dietary factors on bone integrity in children and adolescents. We also briefly describe the specific tools that are currently used in assessing bone health.

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Managing pediatric osteoporosis

Cited by 3 publications

References 15 publications

Vitamin D—update for the pediatric rheumatologists

Vitamin D—update for the pediatric rheumatologists

Association of COL1A1 SP1 and FOK-I VDR Genetic Polymorphisms in Young Male Idiopathic Osteoporosis

Bone modeling, remodeling, and skeletal health in children and adolescents: mineral accrual, assessment and treatment

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