Osteoporosis and Bone Fragility in Children: Diagnostic and Treatment Strategies
Giuseppe Cannalire1, Giacomo Biasucci1,2, Lorenzo Bertolini3
1Paediatrics and Neonatology Unit, University of Parma, Guglielmo da Saliceto Hospital, 43121 Piacenza, Italy.
Insights
Pediatric osteoporosis incidence is rising due to chronic diseases and medications. Management requires evaluating causes and using bone density tests like DXA, with bisphosphonates as a primary treatment.
Area of Science:
- Pediatric Endocrinology
- Bone Metabolism
- Radiology
Background:
- Childhood osteoporosis incidence is increasing, driven by improved survival in chronic diseases and medication side effects.
- Childhood bone fragility has diverse causes, necessitating comprehensive evaluation of contributing pathogenetic mechanisms.
- This review addresses primary and secondary osteoporosis causes in children.
Purpose of the Study:
- To review the primary and secondary causes of pediatric osteoporosis.
- To evaluate radiological methods for assessing bone quality in children.
- To present current and novel diagnostic and therapeutic strategies for childhood bone fragility.
Main Methods:
- Literature review focusing on pediatric osteoporosis etiology, diagnosis, and treatment.
- Analysis of radiological techniques including DXA, CT, ultrasound, and REMS.
- Examination of pharmacological treatments (bisphosphonates, denosumab) and lifestyle interventions.
Main Results:
- DXA remains the gold standard for pediatric bone health assessment, with CT, ultrasound, and REMS gaining traction.
- Bisphosphonate therapy is the established treatment for primary and secondary pediatric osteoporosis.
- Monoclonal antibodies like denosumab show promise for refractory cases and specific conditions.
Conclusions:
- Optimal management of underlying systemic conditions is crucial for treating childhood bone fragility.
- Lifestyle interventions focusing on nutrition (calcium, vitamin D) and physical activity are vital for prevention.
- A multi-faceted approach combining diagnostics, pharmacotherapy, and lifestyle modifications is essential for pediatric osteoporosis.
Abstract:
The incidence of osteoporosis in children is increasing because of the increased survival rate of children with chronic diseases and the increased use of bone-damaging drugs. As childhood bone fragility has several etiologies, its management requires a thorough evaluation of all potentially contributing pathogenetic mechanisms. This review focuses on the main causes of primary and secondary osteoporosis and on the benefits and limits of the different radiological methods currently used in clinical practice for the study of bone quality. The therapeutic and preventive strategies currently available and the most novel diagnostic and treatment strategies are also presented. Optimal management of underlying systemic conditions is key for the treatment of bone fragility in childhood. DXA still represents the gold standard for the radiologic evaluation of bone health in children, although other imaging techniques such as computed tomography and ultrasound evaluations, as well as REMS, are increasingly studied and used. Bisphosphonate therapy is the gold standard for pharmacological treatment in both primary and secondary pediatric osteoporosis. Evidence and experience are building up relative to the use of monoclonal antibodies such as denosumab in cases of poor response to bisphosphonates in specific conditions such as osteogenesis imperfecta, juvenile Paget's disease and in some cases of secondary osteoporosis. Lifestyle interventions including adequate nutrition with adequate calcium and vitamin D intake, as well as physical activity, are recommended for prevention.
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