IBMS BoneKEy | Perspective
Diagnosis and treatment of bone fragility in childhood
Maria Luisa Bianchi
DOI:10.1138/20080336
Abstract
What constitutes “bone fragility” in children and adolescents before the occurrence of fractures is still an unresolved question. In growing subjects, the clinical relevance of uncomplicated low bone mineral density (BMD) and its long-term consequences remain difficult to evaluate, and there is only preliminary evidence that a child's BMD is a predictor of fracture risk. There is no consensus on the threshold values of low BMD that define bone fragility and osteoporosis in the young.
Bone fragility should be suspected in all cases of fractures without evident trauma. In particular, recurrent and multiple fractures must be very carefully evaluated (considering also the possibility of child abuse).
There are primary causes of bone fragility in children and adolescents (e.g., osteogenesis imperfecta) or bone fragility can be caused by many different chronic diseases (e.g., all those treated with long-term glucocorticosteroids).
The increasing number of cases requires the highest attention. Height, weight, pubertal stage, calcium, sodium and protein intake, use and dose of glucocorticosteroids, mobility, pain, fractures (type, circumstances, outcome) are the key elements in the clinical evaluation of children with chronic diseases and possible bone complications.
The evaluation of BMD at this age is problematic, because of the continuous change of skeletal size and shape, and the great individual variability of the growth process, which makes it difficult to identify a meaningful reference population. The treatment of bone fragility is also problematic: bisphosphonates are now increasingly used in severe cases, but their long-term efficacy and safety has still not been demonstrated.
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