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Mineral metabolism and calcitriol therapy in idiopathic juvenile osteoporosis
G Saggese1, S Bertelloni, G I Baroncelli
1Department of Pediatrics, University of Pisa, Italy.
Insights
Idiopathic juvenile osteoporosis in children may improve with calcitriol (1,25-dihydroxycholecalciferol) therapy. Treatment led to reduced fractures and increased bone mineralization, with no observed side effects.
Area of Science:
- Pediatric Endocrinology
- Metabolic Bone Disease
- Nutritional Biochemistry
Background:
- Idiopathic juvenile osteoporosis (IJO) is a rare skeletal disorder affecting children.
- Characterized by low bone mineral density and increased fracture risk.
- Etiology often remains unknown, necessitating investigation into potential therapeutic targets.
Purpose of the Study:
- To evaluate the efficacy and safety of calcitriol in treating children with IJO.
- To assess the impact of calcitriol on bone mineralization and fracture rates.
- To investigate the role of vitamin D metabolites in IJO pathogenesis.
Main Methods:
- Case series of four children (2.3–12.6 years) diagnosed with IJO.
- Comprehensive biochemical assessments including calcium, phosphate, vitamin D metabolites, and parathyroid hormone.
- Treatment with calcitriol (0.25–0.50 μg/day) in three patients.
- Monitoring of fracture incidence and bone mineral density over 12 months.
Main Results:
- Low 1,25-dihydroxyvitamin D levels were observed in most patients.
- Calcitriol therapy significantly reduced fracture rates.
- Bone mineralization improved substantially, reaching normal levels in two children within 12 months.
- The untreated patient showed no improvement in bone mineralization.
Conclusions:
- Calcitriol therapy appears to be an effective treatment for IJO, improving bone health and reducing fractures.
- Vitamin D deficiency, specifically of the active metabolite 1,25-dihydroxyvitamin D, may play a role in IJO.
- Calcitriol treatment demonstrated a favorable safety profile in this pediatric cohort.
Abstract:
Idiopathic juvenile osteoporosis is a rare cause of osteoporosis during childhood. We examined four children (three boys and one girl, ranging in age from 2.3 to 12.6 years) with idiopathic juvenile osteoporosis. All of these patients had normal serum calcium, ionized calcium, phosphate, magnesium, 25-hydroxyvitamin D, intact parathyroid hormone, and total and extractable calcitonin levels. 1,25-Dihydroxyvitamin D values were low in three patients and slightly decreased in one. Three children were treated with calcitriol (1,25-dihydroxycholecalciferol) (0.50 micrograms/d in two and 0.25 microgram/d in the other). The fourth patient was not treated because of parental refusal. Therapy reduced the fracture rate. Follow-up at 6 and 12 months showed a significant increase in bone mineralization, which reached normal values in two children after 12 months of treatment. No side effects of calcitriol therapy were observed. The untreated patient did not show an improvement of bone mineralization in the same time.