Metabolic Bone Disease in Children

Abstract

Metabolic bone disease in children includes many hereditary and acquired conditions of diverse etiology that lead to disturbed metabolism of the bone tissue. Some of these processes primarily affect bone; others are secondary to nutritional deficiencies, a variety of chronic disorders, and/or treatment with some drugs. Some of these disorders are rare, but some present public health concerns (for instance, rickets) that have been well known for many years but still persist. The most important clinical consequences of bone metabolic diseases in the pediatric population include reduced linear growth, bone deformations, and non-traumatic fractures leading to bone pain, deterioration of motor development and disability. In this article, we analyze primary and secondary osteoporosis, rickets, osteomalacia (nutritional and hereditary vitamin D-dependent, hypophosphatemic and that due to renal tubular abnormalities), renal osteodystrophy, sclerosing bony disorders, and some genetic bone diseases (hypophosphatasia, fibrous dysplasia, skeletal dysplasia, juvenile Paget disease, familial expansile osteolysis, and osteoporosis pseudoglioma syndrome). Early identification and treatment of potential risk factors is essential for skeletal health in adulthood. In most conditions it is necessary to ensure an appropriate diet, with calcium and vitamin D, and an adequate amount of physical activity as a means of prevention. In secondary bone diseases, treatment of the primary disorder is crucial. Most genetic disorders await prospective gene therapies, while bone marrow transplantation has been attempted in other disorders. At present, affected patients are treated symptomatically, frequently by interdisciplinary teams. The role of exercise and pharmacologic therapy with calcium, vitamin D, phosphate, bisphosphonates, calcitonin, sex hormones, growth hormone, and thiazides is discussed. The perspectives on future therapy with insulin-like growth factor-1, new analogs of vitamin D, strontium, osteoprotegerin, and calcimimetics are presented.

Predictors and Management Algorithm of Bone Demineralization in Juvenile Idiopathic Arthritis

“…Impaired bone mineralization is a current and important issue in public health, especially among chronic diseases in children, which, according to several studies 26,[36][37][38][39][40][41] , has continuously increased in the last decades. Children with JIA are at risk of developing permanent joint damage because of chronic inflammation and the breakdown of cartilage and bone.…”

Childhood hypophosphatasia: to treat or not to treat

“…Treatment of HPP has historically been supportive in nature, utilizing rehabilitative strategies to minimize functional limitations [ 11 ], surgery to manage some fractures, and in some cases modified diet to correct hypercalcemia [ 12 ]. More recently, enzyme replacement therapy (ERT) has become available for patients with HPP.…”