Management of primary and secondary osteoporosis in children
Sophia D Sakka1, Moira S Cheung2
1Department of Endocrinology and Diabetes, Evelina London Children's Hospital, 3rd Floor, Becket House, Westminster Bridge Road, SE1 7EH, London, UK.
Insights
Pediatric osteoporosis diagnosis and management differ from adults, involving specialized investigations and multidisciplinary care. Bisphosphonates are common treatments, improving bone mineral density and vertebral fractures in children.
Area of Science:
- Pediatric Endocrinology
- Bone Metabolism
- Skeletal Health
Background:
- Pediatric osteoporosis presents unique challenges in definition, diagnosis, and treatment compared to adults.
- Primary causes include osteogenesis imperfecta (OI), while secondary osteoporosis stems from conditions like steroid use, chronic inflammation, and delayed puberty.
Purpose of the Study:
- To outline the distinct diagnostic and therapeutic approaches for osteoporosis in children.
- To emphasize the importance of a multidisciplinary team in managing pediatric bone fragility.
Main Methods:
- Utilizing bone biochemistry, dual-energy X-ray absorptiometry (DXA) for bone densitometry, and vertebral fracture assessment.
- Employing radiographic spine assessment, quantitative computed tomography (QCT), and genetic analysis for diagnosis.
- Adjusting bone mineral density (BMD) results for age, gender, and height is crucial for accurate pediatric assessment.
Main Results:
- Bisphosphonates show efficacy in improving BMD and vertebral fracture reshaping in children.
- Data on bisphosphonates' impact on long bone fractures remain inconclusive, and denosumab use is increasing with varied outcomes.
- Genetic testing aids in classifying primary osteoporosis, while bone turnover markers and biopsies assist in specific cases.
Conclusions:
- Effective management of pediatric osteoporosis requires a specialized, multidisciplinary team focused on fracture prevention and quality of life.
- Early detection through risk factor awareness and screening can prevent further bone damage and treat asymptomatic fractures.
Abstract:
Osteoporosis in children differs from adults in terms of definition, diagnosis, monitoring and treatment options. Primary osteoporosis comprises primarily of osteogenesis imperfecta (OI), but there are significant other causes of bone fragility in children that require treatment. Secondary osteoporosis can be a result of muscle disuse, iatrogenic causes, such as steroids, chronic inflammation, delayed or arrested puberty and thalassaemia major. Investigations involve bone biochemistry, dual-energy X-ray absorptiometry scan for bone densitometry and vertebral fracture assessment, radiographic assessment of the spine and, in some cases, quantitative computed tomography (QCT) or peripheral QCT. It is important that bone mineral density (BMD) results are adjusted based on age, gender and height, in order to reflect size corrections in children. Genetics are being used increasingly for the diagnosis and classification of various cases of primary osteoporosis. Bone turnover markers are used less frequently in children, but can be helpful in monitoring treatment and transiliac bone biopsy can assist in the diagnosis of atypical cases of osteoporosis. The management of children with osteoporosis requires a multidisciplinary team of health professionals with expertise in paediatric bone disease. The prevention and treatment of fragility fractures and improvement of the quality of life of patients are important aims of a specialised service. The drugs used most commonly in children are bisphosphonates, that, with timely treatment, can give good results in improving BMD and reshaping vertebral fractures. The data regarding their effect on reducing long bone fractures are equivocal. Denosumab is being used increasingly for various conditions with mixed results. There are more drugs trialled in adults, but these are not yet licenced for children. Increasing awareness of risk factors for paediatric osteoporosis, screening and referral to a specialist team for appropriate management can lead to early detection and treatment of asymptomatic fractures and prevention of further bone damage.
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