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Osteoporosis International

, Volume 27, Issue 7, pp 2147–2179 | Cite as

The management of osteoporosis in children

  • L. M. WardEmail author
  • V. N. Konji
  • J. Ma
Review

Summary

This article reviews the manifestations and risk factors associated with osteoporosis in childhood, the definition of osteoporosis and recommendations for monitoring and prevention. As well, this article discusses when a child should be considered a candidate for osteoporosis therapy, which agents should be prescribed, duration of therapy and side effects.

Abstract

There has been significant progress in our understanding of risk factors and the natural history of osteoporosis in children over the past number of years. This knowledge has fostered the development of logical approaches to the diagnosis, monitoring, and optimal timing of osteoporosis intervention in this setting. Current management strategies are predicated upon monitoring at-risk children to identify and then treat earlier rather than later signs of osteoporosis in those with limited potential for spontaneous recovery. On the other hand, trials addressing the prevention of the first-ever fracture are still needed for children who have both a high likelihood of developing fractures and less potential for recovery. This review focuses on the evidence that shapes the current approach to diagnosis, monitoring, and treatment of osteoporosis in childhood, with emphasis on the key pediatric-specific biological principles that are pivotal to the overall approach and on the main questions with which clinicians struggle on a daily basis. The scope of this article is to review the manifestations of and risk factors for primary and secondary osteoporosis in children, to discuss the definition of pediatric osteoporosis, and to summarize recommendations for monitoring and prevention of bone fragility. As well, this article reviews when a child is a candidate for osteoporosis therapy, which agents and doses should be prescribed, the duration of therapy, how the response to therapy is adjudicated, and the short- and long-term side effects. With this information, the bone health clinician will be poised to diagnose osteoporosis in children and to identify when children need osteoporosis therapy and the clinical outcomes that gauge efficacy and safety of treatment.

Keywords

Bisphosphonates Bone density Bone fragility Denosumab Diagnosis Monitoring Osteoporosis Treatment Vertebral fractures 

Abbreviations

ALL

Acute lymphoblastic leukemia

AFF

Atypical femur fractures

AN

Anorexia nervosa

BMD

Bone mineral density

BMAD

Bone mineral apparent density

BTM

Bone turnover markers

CTx

Collagen type I cross-linked C-telopeptide

DMD

Duchenne muscular dystrophy

DXA

Dual energy X-ray absorptiometry

GC

Glucocorticoid(s)

ISCD

International Society for Clinical Densitometry

IV

Intravenous

LS

Lumbar spine

NTx

Collagen type I cross-linked N-telopeptides

OI

Osteogenesis imperfecta

ONJ

Osteonecrosis of the jaw

PINP

Procollagen type I N-terminal propeptide

pQCT

Peripheral quantitative computed tomography

PTH

Parathyroid hormone

SD

Standard deviation

SDI

Spinal deformity index

VF

Vertebral fracture(s)

VFA

Vertebral fracture assessment (by DXA)

Notes

Acknowledgments

This work was supported by the following programs and organizations: (1) LMW: the Canadian Institutions for Health Research Operating Grants Program, the Canadian Institutes for Health Research New Investigator Program, The Canadian Child Health Clinician Scientist Program, the Children’s Hospital of Eastern Ontario (CHEO) Research Institute, The University of Ottawa Research Chair Program, and the CHEO Departments of Pediatrics and Surgery: (2) VK: The CHEO Department of Surgery; and (3) JM: The CHEO Research Institute.

Compliance with ethical standards

Conflicts of interest

LMW has been a consultant to Novartis Pharmaceuticals, Amgen, and Alexion Pharmaceuticals. VNK and JM have no conflicts of interest to disclose.

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2016

Authors and Affiliations

  1. 1.Pediatric Bone Health Clinical and Research ProgramsChildren’s Hospital of Eastern OntarioOttawaCanada
  2. 2.Department of PediatricsUniversity of OttawaOttawaCanada
  3. 3.School of Epidemiology, Public Health and Preventive MedicineUniversity of OttawaOttawaCanada

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