Endocrine Abstracts

Osteoporosis, a skeletal disorder with bone fragility, is rare in children and adolescents. The diagnosis is based on low BMD (Z-score <-2.0, appropriately adjusted for height and skeletal maturity) and a fracture history indicative of higher-than-normal bone fragility. Compared with primary osteoporosis (various genetic forms), secondary osteoporosis is more common and poses major treatment challenges in various pediatric subspecialties. Many chronic diseases and their treatment can impair childhood bone mass development and lead to osteoporosis. In the absence of a known chronic disease, fragility fractures and low BMD should prompt extensive screening for secondary causes. Genetic skeletal fragility disorders should be considered when no secondary cause can be identified. Management consists of treatment of the underlying illness and optimizing calcium and vitamin D intake and physical activity. Treatment with bone-active medication should be considered on a personalized basis, depending on the severity of osteoporosis and the underlying disease and its anticipated prognosis versus the absence of evidence of anti-fracture efficacy and potential harmful effects of pharmacotherapies. Only few large-scale studies with pharmacological treatment have been performed in childhood osteoporosis and most of them had BMD and not fractures as a primary outcome. When treatment of the underlying cause is not possible or effective and fracture risk appears high, antiresorptive drugs should be considered. Treatment with bisphosphonates has been shown to improve BMD in several underlying conditions but data on fracture prevention are mostly lacking. Rebound hypercalcemia after denosumab use limits its benefits in children. Anti-sclerostin antibody and other osteoanabolic treatments will hopefully in the future be available for selected pediatric patient groups. The management of children and adolescents with osteoporosis and fragility fractures requires a patient-centered multidisciplinary approach.

Key learning points: • Secondary osteoporosis has emerged as an important pediatric disease and involves all pediatric subspecialties.

• Evaluation of skeletal health should be part of chronic illness management for early diagnosis and timely treatment of pediatric osteoporosis.

• Pharmacotherapy, usually antiresorptives, needs to be determined on individual basis, considering the severity of osteoporosis, the underlying disease and its anticipated prognosis.

• Treatment options are limited and their efficacy inadequately established.

• There is need for osteoanabolic treatment options both in primary and secondary childhood osteoporosis.