Clinical Pediatrics

Osteoporosis is defined as a systemic skeletal disease characterized by compromised bone strength, and microarchitectural deterioration of bone, leading to fragility fractures. Once thought to be a unique health problem in older adults, osteoporosis has now been recognized as a condition also seen in pediatric patients. Osteoporosis in children has a broad range of etiologies, and is classified into 2 groups: primary osteoporosis or genetic bone disease, and secondary osteoporosis due to underlying chronic diseases. The diagnosis of osteoporosis in children should not be made on the basis of densitometric criteria alone. The presence  of bone fragility with a history of clinically significant fractures and significantly low bone density are required for diagnosis of pediatric osteoporosis. Vertebral fracture in the absence of high energy trauma or local disease is pathognomonic for osteoporosis and can allow the diagnosis without detection of significantly low bone density. Monitoring for bone health should include screening for vertebral fractures that are common and often asymptomatic in children with risk factors for osteoporosis. Other diagnostic studies include biochemical markers of bone turnover, bone mineral density by dual energy x-ray absorptiometry, as well as spinal imaging using densitometric lateral spinal imaging. Optimizing bone health in children with osteoporosis includes treating the underlying condition causing bone fragility, and ensuring adequate weight-bearing exercise, vitamin D and calcium intake. Pharmacologic agents should be offered to patients with fragility fractures. Bisphosphonates have been used successfully in pediatric patients.  This lecture reviews the latest advances in the assessment and treatment of pediatric osteoporosis.