Osteoporosis and Bone Fragility in Children: Diagnostic and Treatment Strategies
Abstract
:1. Introduction
2. Methods
Literature Search Strategy and Selection Criteria
3. Discussion
3.1. Primary Osteoporosis
3.2. Secondary Osteoporosis
4. Evaluation of Bone Health and Bone Density in Children
4.1. Physical Examination and Biochemical Exams
4.2. Skeletal Imaging Techniques
4.3. Ultrasound Evaluation of BMD
5. Treatment and Prevention
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
BMD | bone mineral density |
DXA | dual-energy X-ray absorptiometry |
OI | osteogenesis imperfecta |
EDCs | endocrine-disrupting chemicals |
QCT | quantitative computed tomography |
QUS | quantitative ultrasound |
REMS | radiofrequency echographic multi-spectrometry |
MRI | magnetic resonance imaging |
BPs | bisphosphonates |
DB | denosumab |
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Nomenclature | Gene | Clinical Classification by Severity Grading Scale | |
---|---|---|---|
Non-deforming OI with blue sclerae | 1. COL1A1 2. COL1A2 | MILD OI: Bone problems
| Bone density and other features:
|
Common Variable with normal sclerae | 1. COL1A1 2. COL1A2 3. WNT1a 1. CRTAP 2. PPIB 3. SP7 1. PLS3 | MODERATE OI: Bone problems:
| Bone density and other features:
|
OI with interosseous membranes Calcifications | 1. IFITM5 | ||
Progressively deforming | 1. COL1A1 2. COL1A2 1. BMP1 2. CRTAP 3. FKBP10 4. LEPRE1 5. PLOD2 6. PPIB 7. SERPINF1 8. SERPINH1 9. MEM38B 10. WNT1 11. CREB3L1 | SEVERE OI: Bone problems:
| Bone density and other features:
|
Letal perinatal OI | 1. COL1A1 2. COL1A2 1. CRTAP 2. LEPRE1 3. PPIB | EXTREMELY SEVERE OI: Bone problems:
| Bone density and other features:
|
MAIN IMAGING MODALITIES FOR BONE HEALTH EVALUATION IN CHILDREN | |||
---|---|---|---|
Imaging Modality | Sites of Application | Relevant Advantages | Relevant Disadvantages |
DXA |
| Gold standard |
|
CT Includes QCT, pQCT (and HR-pQCT) and vQCT |
|
| Radiation |
QUS |
|
|
|
MRI Includes micro-MRI |
|
| |
REMS |
|
|
|
Age | Calcium (mg) | 25 OH Vitamin D (IU) |
---|---|---|
0–6 months | 200 | 400 |
6–12 months | 260 | 400 |
1–3 years | 700 | 600 |
4–8 years | 1000 | 600 |
9–18 years | 1300 | 600 |
Drug | Contraindications | Administration | Dose |
---|---|---|---|
Pamidronate (2nd generation) | Hypocalcemia, severe renal failure, hypersensitivity | IV, diluted in 100–250 mL physiological saline solution for 3–4 h | <1 year: 0.5 mg/kg every 2 months 1–2 years: 0.25–0.5 mg/kg/day for 3 days every 3 months 2–3 years: 0.375–0.75 mg/kg/day for 3 days every 3 months >3 years: 0.5–1 mg/kg/day for 3 days every 4 months Maximum dose: 60 mg/dose and 11.5 mg/kg/year |
Neridronate (3rd generation) | Hypocalcemia, severe renal failure, hypersensitivity | IV, diluted in 200–250 mL physiological saline solution for 3 h | 1–2 mg/kg every 3–4 months |
Zolendronate (3rd generation) | Hypocalcemia, severe renal failure, hypersensitivity | IV, diluted in 50 mL physiological saline solution for 30−45 min | 0.0125–0.05 mg/kg every 6–12 months (maximum dose: 4 mg) |
Alendronate (2nd generation) | Hypocalcemia, delayed esophageal emptying, severe renal failure, hypersensitivity, inability to stand or sit for at least 30 min | Oral | 1–2 mg/kg/week <40 kg: 5 mg/day or 35 mg/week >40 kg: 10 mg/day or 70 mg/week Maximum dose: 70 mg/week |
Risendronate (3rd generation) | Hypocalcemia, delayed esophageal emptying, severe renal failure, hypersensitivity, inability to stand or sit for at least 30 min | Oral | 15 mg/week (<40 kg); 30 mg/week (>40 kg) Maximum dose: 30 mg/week |
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Cannalire, G.; Biasucci, G.; Bertolini, L.; Patianna, V.; Petraroli, M.; Pilloni, S.; Esposito, S.; Street, M.E. Osteoporosis and Bone Fragility in Children: Diagnostic and Treatment Strategies. J. Clin. Med. 2024, 13, 4951. https://doi.org/10.3390/jcm13164951
Cannalire G, Biasucci G, Bertolini L, Patianna V, Petraroli M, Pilloni S, Esposito S, Street ME. Osteoporosis and Bone Fragility in Children: Diagnostic and Treatment Strategies. Journal of Clinical Medicine. 2024; 13(16):4951. https://doi.org/10.3390/jcm13164951
Chicago/Turabian StyleCannalire, Giuseppe, Giacomo Biasucci, Lorenzo Bertolini, Viviana Patianna, Maddalena Petraroli, Simone Pilloni, Susanna Esposito, and Maria Elisabeth Street. 2024. "Osteoporosis and Bone Fragility in Children: Diagnostic and Treatment Strategies" Journal of Clinical Medicine 13, no. 16: 4951. https://doi.org/10.3390/jcm13164951