Pediatric Osteoporosis

What is osteoporosis?

Osteoporosis is a condition in which the bones are weak and likely to fracture. Although much more common in older adults, especially women during and after menopause, osteoporosis can also occur during childhood. The definition of diagnosis of osteoporosis in childhood is different than in adults and is based on a history of fractures AND low bone mineral density on DXA bone density test. Most often, osteoporosis during childhood is caused by an underlying medical condition (called secondary osteoporosis) or a genetic disorder (such as osteogenesis imperfecta). Sometimes, no cause can be found and the disease is categorized as a rare form of osteoporosis, called idiopathic juvenile osteoporosis (IJO).

What causes osteoporosis in children?

In children, the following medical conditions or medications can lead to osteoporosis.

Secondary osteoporosis

These are caused by an underlying medical condition:

• Chronic inflammatory disease like Crohn's disease or juvenile arthritis

• Prematurity

• Cerebral palsy

• Malabsorption syndromes

• Liver disease like biliary atresia

• Osteogenesis imperfecta

• Metabolic conditions like homocystinuria or lysosomal disease

• Type 1 diabetes

• Cancer

• Hyperparathyroidism

• Cushing's syndrome

• Anorexia nervosa

• Kidney disease

Medicines

Osteoporosis can also be caused by the following medications:

• Steroids

• Anticonvulsants (for seizures)

• Corticosteroids

• Immunosuppressive medications

Lifestyle

• Excessive inactivity or immobility

• Dietary calcium and vitamin D deficiency

• Excessive exercising leading to energy imbalance and weight loss

What are the symptoms of osteoporosis in children?

You should be concerned that your child might have osteoporosis if he or she has had multiple fractures or any fracture that occurred in the absence of trauma (for example, tripping over a curb and breaking a leg).

How is juvenile osteoporosis diagnosed?

The diagnosis of osteoporosis in children requires a history of fractures and in most cases a finding of low bone mineral density on a DXA scan.

• Review of medical history, medications, and family medical history

• Skeletal X-rays. A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

• DXA scan. A diagnostic procedure to determine bone mineral density

• Blood and urine tests. Tests to measure calcium, phosphorus, vitamin D and hormones.

Treatment for osteoporosis in children

All children with osteoporosis will be evaluated to make sure they are receiving enough calcium and vitamin D in their diet and to be sure they are getting enough weight bearing exercise. In most cases, children with osteoporosis will be treated with a type of medication called bisphosphonates. These medications work to improve bone density and thereby strengthen bones.

• Nutrition evaluation and supplementation with calcium and vitamin D, if necessary

• Physical therapy evaluation and recommendation for weight bearing exercises such as walking or time in a stander

• Bisphosphonates. Names of bisphosphonates commonly include "zoledronic acid," "pamidronate," and "alendronate"