Osteoporosis is a progressive metabolic bone disease that decreases bone mineral density, with deterioration of bone structure. Skeletal fragility leads to fractures with minor trauma. Diagnosis is by dual-energy x-ray absorptiometry (DXA) scan and by fracture history. Treatment includes bisphosphonates, calcium and vitamin D supplements, and physical activity.Osteoporosis is a progressive metabolic bone disease that decreases bone mineral density, with deterioration of bone structure. Skeletal fragility leads to fractures with minor trauma. Diagnosis is by dual-energy x-ray absorptiometry (DXA) scan and by fracture history. Treatment includes bisphosphonates, calcium and vitamin D supplements, and physical activity.
In children, osteoporosis may occur as a primary disorder or as a secondary disorder resulting from chronic illness, medications, immobility, or nutritional deficiencies.
Idiopathic juvenile osteoporosis is a rare form of osteoporosis that is diagnosed when a child with normal gonadal function presents with fragility fractures and low bone mass without an identifiable underlying cause.
Symptoms and Signs of Osteoporosis in Children
Osteoporosis in children is characterized by bone fragility leading to low-trauma fractures, particularly in long bones and vertebrae, and sometimes bone pain.
Vertebral fractures can cause back pain, height loss, or spinal curvature but may be asymptomatic and found incidentally during imaging.
Diagnosis of Osteoporosis in Children
Dual-energy x-ray absorptiometry (DXA) scan
Fracture history
A diagnosis of osteoporosis in children requires both low bone mineral density and a clinically significant fracture history.
Low bone density is measured with a DXA scan. DXA is the gold standard in children. A Z-score is the number of standard deviations a patient’s bone density is above or below the average. The Z-score result of the scan compares a child’s bone mass to age-, sex-, and body size–matched norms. A Z-score of ≤ –2.0 indicates low bone mineral density.
Fracture history includes ≥ 1 vertebral compression fractures regardless of bone density and in the absence of other local disease or trauma, or ≥ 2 long bone fractures by age 10, or ≥ 3 long bone fractures by age 19.
Treatment of Osteoporosis in Children
Bisphosphonates
Lifestyle modifications
Bisphosphonates are the primary treatment for osteoporosis in children and are usually complemented by lifestyle interventions (eg, ensuring adequate intake of calcium and vitamin D, physical activity) (Bisphosphonates are the primary treatment for osteoporosis in children and are usually complemented by lifestyle interventions (eg, ensuring adequate intake of calcium and vitamin D, physical activity) (1).
Treatment reference
1. Shapiro G, Fishleder J, Stepensky P, Simanovsky N, Goldman V, Lamdan R. Skeletal Changes After Hematopoietic Stem Cell Transplantation in Osteopetrosis. J Bone Miner Res. 2020;35(9):1645-1651. doi:10.1002/jbmr.4037
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