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Anabolic Therapy for the Treatment of Osteoporosis in Childhood

  • Pediatrics (L Ward and E Imel, Section Editors)
  • Published:
Current Osteoporosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Numerous forms of osteoporosis in childhood are characterized by low bone turnover (for example, osteoporosis due to neuromuscular disorders and glucocorticoid exposure). Anti-resorptive therapy, traditionally used to treat osteoporosis in the young, is associated with further reductions in bone turnover, raising concerns about the long-term safety and efficacy of such therapy. These observations have led to increasing interest in the role of anabolic therapy to treat pediatric osteoporosis.

Recent Findings

While growth hormone and androgens appears to be relatively weak anabolic modulators of bone mass, emerging therapies targeting bone formation pathways (anti-transforming growth factor beta antibody and anti-sclerostin antibody) hold considerable promise. Teriparatide remains an attractive option that merits formal study for patients post-epiphyseal fusion, although it must be considered that adult studies have shown its effect is blunted when administered following bisphosphonate therapy. Mechanical stimulation of bone through whole body vibration therapy appears to be much less effective than bisphosphonate therapy for treating osteoporosis in children.

Summary

New anabolic therapies which target important pathways in skeletal metabolism merit further study in children, including their effects on fracture risk reduction and after treatment discontinuation.

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Abbreviations

bb:

Black bear

BMC:

Bone mineral content

BMD:

Bone mineral density

DXA:

Dual energy x-ray absorptiometry

DMD:

Duchenne muscular dystrophy

GH:

Growth hormone

GHD:

Growth hormone deficiency

OPPG:

Osteoporosis pseudoglioma syndrome

PMO:

Post-menopausal osteoporosis

PTH:

Parathyroid hormone

pQCT:

Peripheral quantitative computed tomography

TGF-beta:

Transforming growth factor beta

WBV:

Whole body vibration

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Acknowledgements

Dr. Ward is supported by a Research Chair Award from the University of Ottawa.

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Authors and Affiliations

  1. Department of Pediatrics, Faculty of Medicine, University of Ottawa and Division of Endocrinology and Metabolism, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada

    Leanne M. Ward

  2. Department of Pediatrics, Faculty of Medicine, McGill University, and Shriners Hospital for Children, 1003 Boulevard Décarie, Montréal, Québec, H4A 0A9, Canada

    Frank Rauch

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Correspondence to Leanne M. Ward.

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Leanne Ward is participating in clinical trials with AMGEN, outside the submitted work. Frank Rauch declares no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Pediatrics

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Ward, L.M., Rauch, F. Anabolic Therapy for the Treatment of Osteoporosis in Childhood. Curr Osteoporos Rep 16, 269–276 (2018). https://doi.org/10.1007/s11914-018-0434-z

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