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  • Review Article
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Causes, mechanisms and management of paediatric osteoporosis

Nature Reviews Rheumatology volume 9, pages 465–475 (2013)Cite this article

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Abstract

Osteoporosis, a skeletal disorder characterized by compromised bone strength and an increased risk of fractures, is an important paediatric disorder that involves almost all paediatric subspecialties. Osteogenesis imperfecta is the most common form of childhood-onset primary osteoporosis, but several other forms are also known. Secondary osteoporosis is caused by an underlying chronic illness or its treatment. The most common causes of secondary osteoporosis include chronic systemic inflammation, glucocorticoid use and neuromuscular disabilities. The skeletal sequelae can present in childhood as low-energy peripheral and vertebral fractures, or become evident in adulthood as low bone mass and an increased propensity to develop osteoporosis. Management should aim at prevention, as interventions to treat symptomatic osteoporosis in the paediatric age group are scarce. Bisphosphonates are the principal pharmacological agents that can be used in this setting, but data on their efficacy and safety in paediatric populations remain inadequate, especially in patients with secondary osteoporosis. Consequently, it is important to understand the potential skeletal effects of paediatric illnesses and their therapies in order to institute effective and timely prevention of skeletal complications.

Key Points

  • Osteoporosis has become an important paediatric illness and can affect patients in any paediatric subspecialty

  • Osteogenesis imperfecta is the most common form of primary osteoporosis in the paediatric age group and includes several forms with variable severity

  • Secondary osteoporosis is common in children with illnesses that involve chronic systemic inflammation, neuromuscular disabilities, or glucocorticoid treatment

  • Osteoporosis presents as low bone mineral density and an increased risk of fractures in the vertebrae and limb bones

  • Preventive measures include optimal control of the underlying illness, vitamin D supplementation and maintenance of weight-bearing activity

  • Bisphosphonates are increasingly being used in children, but data on their efficacy and safety in paediatric patients are inadequate, especially with regard to treatment of secondary osteoporosis

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Figure 1: An algorithm for assessment of an otherwise healthy child who presents with a new fracture.
Figure 2: Factors linked to osteoporosis in children with an underlying chronic illness.
Figure 3: Glucocorticoids induce abnormal bone remodelling.

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Acknowledgements

O. Mäkitie's research work is supported by grants from The Finnish Foundation for Paediatric Research, the Academy of Finland, the Sigrid Jusélius Foundation, Folkhälsan Research Foundation, Helsinki University Central Hospital Research Funds, and by the Sabbatical Leave Programme of the European Society for Paediatric Endocrinology, which is supported by an educational grant from Eli Lilly.

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  1. Children's Hospital, Helsinki University Central Hospital, University of Helsinki,

    Outi Mäkitie

  2. Folkhälsan Research Center, P. O. Box 281, Helsinki, FIN-00029, Finland

    Outi Mäkitie

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Mäkitie, O. Causes, mechanisms and management of paediatric osteoporosis. Nat Rev Rheumatol 9, 465–475 (2013). https://doi.org/10.1038/nrrheum.2013.45

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