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Osteoporosis in children and adolescents: how to treat and monitor?

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Abstract

Osteoporosis is a condition of increased bone fragility associated with fractures. Apart from primary genetic osteoporotic conditions, secondary osteoporosis in children is being increasingly recognized. As a result, there is growing interest in its prevention and treatment. Important goals of care are to prevent fractures, increase bone mass and trabecular and cortical thickness, reshape vertebral fractures, prevent (or correct) skeletal deformities, and improve mobility, independence, and quality of life. Secondary pediatric osteoporosis is often of multifactorial origin since affected children frequently have more than one acquired factor that is detrimental to bone health. Typical conditions causing osteoporosis are leukemias, progressive muscle or neurological disorders, as well as chronic inflammatory conditions and their treatment. Management of children with osteoporosis involves a multidisciplinary team involving pediatric experts from different subspecialties. With regard to prevention and early intervention, it is important to provide optimal management of any underlying systemic conditions including avoidance, or dose-reduction, of osteotoxic medications. Basic supporting life-style measures, such as appropriate nutrition, including adequate calcium intake and vitamin D, and physical activity are recommended, where possible. When pediatric treatment criteria for osteoporosis are met, antiresorptive drugs constitute the first pharmacological line treatment.

Conclusion: This clinical review focuses on the prevention, treatment, and follow-up of children with, or at risk of developing, osteoporosis and the transition from pediatric to adult care.

What is Known:

• Osteoporosis and associated fractures can cause significant morbidity and reduce the quality of life.

• The developing skeleton has huge potential for recovery and reshaping, thus early detection of fractures, assessment of recovery potential, and treatment of children with osteoporosis can prevent future fractures, deformities, and scoliosis, improve function and mobility, and reduce pain.

What is New:

• Osteoporosis in children and adolescents requires a multidisciplinary approach with a thorough assessment of recovery potential, and indication for therapy should be personalized.

• Although bisphosphonates still represent the drug most commonly used to increase bone mass, improve mobility, and reduce pain and recurrence of fractures, new agents are being developed and could be beneficial in children with specific conditions.

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Abbreviations

BMD:

Bone mineral density

BPs:

Bisphosphonates

DMD:

Duchenne muscular dystrophy

DXA:

Dual-energy x-ray absorptiometry

GCs:

Glucocorticoids

GCTB:

Giant cell tumor of the bone

ISCD:

International Society for Clinical Densitometry

JIO:

Juvenile idiopathic osteoporosis

OI:

Osteogenesis imperfecta

ONJ:

Osteonecrosis of the jaw

VFA:

Vertebral fractures assessment

VFs:

Vertebral fractures

WBV:

Whole body vibration therapy

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Authors and Affiliations

  1. Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center, Sophia Children’s Hospital, Rotterdam, The Netherlands

    Silvia Ciancia & Theo C. J. Sas

  2. Department of Pediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz, Austria

    Wolfgang Högler

  3. Department of Orthopedic Surgery, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands

    Ralph J. B. Sakkers

  4. Department of Internal Medicine, Subdivision of Endocrinology, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands

    Natasha M. Appelman-Dijkstra

  5. Department of Pediatrics, Subdivision of Endocrinology, University Medical Center Groningen, Beatrix Childrens Hospital, University of Groningen, Groningen, The Netherlands

    Annemieke M. Boot

  6. Center for Pediatric and Adult Diabetes Care and Research, Rotterdam, The Netherlands

    Theo C. J. Sas

  7. Department of Pediatrics, Albert Schweitzer Hospital, Dordrecht, The Netherlands

    Judith S. Renes

  8. Dutch Growth Research Foundation, Rotterdam, The Netherlands

    Judith S. Renes

Authors
  1. Silvia Ciancia
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  2. Wolfgang Högler
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  3. Ralph J. B. Sakkers
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  4. Natasha M. Appelman-Dijkstra
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  5. Annemieke M. Boot
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  6. Theo C. J. Sas
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  7. Judith S. Renes
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Contributions

All authors contributed to the study conception and design and to the literature search. The first draft of the manuscript was written by Silvia Ciancia and Judith S. Renes. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Silvia Ciancia.

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Ciancia, S., Högler, W., Sakkers, R.J.B. et al. Osteoporosis in children and adolescents: how to treat and monitor?. Eur J Pediatr 182, 501–511 (2023). https://doi.org/10.1007/s00431-022-04743-x

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