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Aging and its effect on bone remodeling is the most common cause of bone disorders. In young and healthy people, bone deposition and resorption happen at an equal rate to maintain optimal bone health.
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The endocrine system produces and secretes hormones, which interact with the skeletal system. These hormones control bone growth, maintain bone once it is formed, and remodel it.
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Osteoclasts are cells responsible for bone resorption and remodeling. They originate from hematopoietic progenitor cells present in the bone marrow. Numerous progenitor cells fuse to form multinucleated cells, each with 10-20 nuclei. A single osteoclast has a diameter of 150 to 200 µM. These cells have ruffled borders that break down the underlying bone tissue and release minerals such as calcium into the blood in bone resorption. Osteoclasts cling to bones with their ruffled edges during...
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Bone remodeling is a continuous and balanced process of bone resorption by osteoclasts and bone formation by osteoblasts. In adults, it helps maintain bone mass and calcium homeostasis. While mechanical stress can stimulate turnover as part of the normal maintenance and reparative process, several hormones also regulate bone remodeling.
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Early-Onset Osteoporosis.

Outi Mäkitie1,2,3, M Carola Zillikens4

  • 1Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. outi.makitie@helsinki.fi.

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Osteoporosis in young individuals is rare and often linked to secondary causes or monogenic bone diseases. Early diagnosis and personalized management, including lifestyle optimization, are crucial for effective treatment.

Keywords:
Early-onset osteoporosisFragility fracturesOsteogenesis imperfectaOsteoporosis in children

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Area of Science:

  • Bone biology and skeletal disorders
  • Genetics and molecular pathology of bone diseases
  • Pediatric and adolescent endocrinology

Background:

  • Osteoporosis, characterized by bone fragility, typically affects the elderly but can occur in younger populations.
  • Diagnosis in children and young adults involves low bone mineral density (BMD) and fragility fractures, often indicating secondary causes.
  • Secondary causes are found in up to 90% of cases, necessitating thorough screening.

Purpose of the Study:

  • To review the definition and diagnostic approaches for osteoporosis in children and young adults.
  • To highlight the importance of identifying secondary causes and monogenic bone diseases.
  • To discuss current management strategies for young patients with osteoporosis.

Main Methods:

  • Literature review of osteoporosis in pediatric and young adult populations.
  • Analysis of diagnostic criteria including bone mineral density (BMD) Z-scores and T-scores.
  • Examination of genetic factors and secondary causes contributing to early-onset osteoporosis.

Main Results:

  • Osteoporosis in the young is often secondary to chronic diseases or medication use (e.g., glucocorticoids).
  • Monogenic bone diseases, involving genes like LRP5, WNT1, PLS3, and SGMS2, are critical considerations when no secondary cause is found.
  • Management focuses on addressing secondary factors, optimizing lifestyle (calcium, vitamin D, exercise), and personalized medication.

Conclusions:

  • Early-onset osteoporosis requires comprehensive evaluation to identify underlying secondary or monogenic causes.
  • Personalized management is key, balancing treatment benefits against limited evidence on long-term efficacy and safety in young populations.
  • Further research is needed on the anti-fracture efficacy and safety of bone-active medications in young individuals, especially concerning pregnancy.