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Part I: Which Child with a Chronic Disease Needs Bone Health Monitoring?

  • Pediatrics (C Munns and F Rauch, Section Editors)
  • Published:
Current Osteoporosis Reports Aims and scope Submit manuscript

Abstract

Purpose of the Review

Underlying conditions which adversely affect skeletal strength are one of the most common reasons for consultations in pediatric bone health clinics. The diseases most frequently linked to fragility fractures include leukemia and other cancers, inflammatory disorders, neuromuscular disease, and those treated with osteotoxic drugs (particularly glucocorticoids). The decision to treat a child with secondary osteoporosis is challenged by the fact that fractures are frequent in childhood, even in the absence of risk factors. Furthermore, some children have the potential for medication-unassisted recovery from osteoporosis, obviating the need for bisphosphonate therapy.

Recent Findings

Over the last decade, there have been important advances in our understanding of the skeletal phenotypes, fracture frequencies, and risk factors for bone fragility in children with underlying disorders. With improved knowledge about the importance of fracture characteristics in at-risk children, there has been a shift away from a bone mineral density (BMD)–centric definition of osteoporosis in childhood, to a fracture-focused approach. As a result, attention is now drawn to the early identification of fragility fractures, which includes asymptomatic vertebral collapse. Furthermore, even a single, long bone fracture can represent a major osteoporotic event in an at-risk child.

Summary

Fundamental biological principles of bone strength development, and the ways in which these go awry in chronic illnesses, form the basis for monitoring and diagnosis of osteoporosis in children with underlying conditions. Overall, the goal of monitoring is to identify early, rather than late, signs of osteoporosis in children with limited potential to undergo medication-unassisted recovery. These are the children who should undergo bisphosphonate therapy, as discussed in part 1 (monitoring and diagnosis) and part 2 (recovery and the decision to treat) of this review.

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Abbreviations

BMD:

Bone mineral density

DXA:

Dual-energy x-ray absorptiometry

DMD:

Duchenne muscular dystrophy

GC:

Glucocorticoid(s)

ISCD:

International Society for Clinical Densitometry

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Acknowledgements

Dr. Ward thanks the research staff and scientists affiliated with The Ottawa Pediatric Bone Health Research Group and The CHEO Genetic and Metabolic Bone Disease Clinic who have been dedicated to the study and care of children with osteoporosis for many years, including Maya Scharke; Elizabeth Sykes; Lynn MacLeay; Scott Walker; Colleen Hartigan; members of the Canadian STeroid-induced Osteoporosis in the Pediatric Population (STOPP) Consortium; and Drs. Kerry Siminoski, Frank Rauch, Marie-Eve Robinson, Karine Khatchadourian, Jacob Jaremko, Nazih Shenouda, Mary-Ann Matzinger, Khaldoun Koujok, Jinhui Ma, Stefan Jackowski, Nasrin Khan, and Victor Konji.

Funding

Dr. Ward has been supported by Tier 1 and Tier 2 Research Chair Awards from the University of Ottawa since 2010, the Children’s Hospital of Eastern Ontario Departments of Pediatrics and Surgery, and the Children’s Hospital of Eastern Ontario Research Institute. The STeroid-induced Osteoporosis in the Pediatric Population (STOPP) study was funded by the Canadian Institutes of Health Research (Funding Reference Number 64285).

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Authors and Affiliations

  1. Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada

    Leanne M. Ward

  2. The Ottawa Pediatric Bone Health Research Group, The CHEO Pediatric Genetic and Metabolic Bone Disease Clinic, The Children’s Hospital of Eastern Ontario (CHEO), Room 250H, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada

    Leanne M. Ward

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Correspondence to Leanne M. Ward.

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Conflict of Interest

Dr. Ward has participated in clinical trials with ReveraGen BioPharma, PTC Therapeutics, Catabasis Pharmaceuticals, Novartis, and Amgen. Dr. Ward has also received consulting fees from PTC Therapeutics, Novartis and Amgen, with funds to the Children’s Hospital of Eastern Ontario Research Institute.

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Ward, L.M. Part I: Which Child with a Chronic Disease Needs Bone Health Monitoring?. Curr Osteoporos Rep 19, 278–288 (2021). https://doi.org/10.1007/s11914-021-00667-x

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