Pediatric osteoporosis

Abstract

Osteoporosis is defined as pathologic condition of the skeleton with impaired bone microarchitecture and increased bone fragility. In contrast to the well-established standards of care for adult-onset types of osteoporosis, such as postmenopausal osteoporosis, specific guidelines on diagnostics and treatments in pediatric populations have emerged just in recent years. Two major types of pediatric osteoporosis can be distinguished: Primary osteoporosis is caused by mutations in structural or regulatory genes of the skeleton, such as collagen 1A1/2. The resulting qualitative or quantitative deficits in bone structure lead to a broad spectrum of bone frailty and soft tissue affection as observed in the different types of osteogenesis imperfecta. Specialized pediatric care involves multidisciplinary management including functional therapy and pharmacologic treatment with bisphosphonates. Secondary osteoporosis as a symptom of nonprimary bone-related conditions represents a much more prevalent condition as compared to primary osteoporosis. Due to the diverse etiologies and underlying pathomechanisms, clinical features vary from case to case and data on specific therapeutic measures is sparse. Patient management has to be tailored to the individual need of the patient and can include bisphosphonate treatment and induction of puberty besides optimization of the underlying condition and functional therapeutic measures. This review aims to provide an overview on diagnostics and current therapeutic options for pediatric osteoporosis and to give insights into recent developments with relevance for primary and secondary care.