Osteoporosis in pediatrics.

Abstract

1. Joel Steelman, MD* 2. Philip Zeitler, MD, PhD† 1. 2. *Pediatric Endocrine Fellow. 3. 4. †Assistant Professor of Pediatric Endocrinology, The Childern’s Hospital, Denver, CO. Dr Zeitler has received a supply of drugs from Novartis Pharmaceuticals for a research protocol. Objectives After completing this article, readers should be able to: 1. Identify determinants of bone mass. 2. Delineate pediatric populations at risk for osteoporosis. 3. Describe test procedures to measure parameters such as bone mineral density, bone formation, and bone resorption. 4. Describe methods to interpret pediatric DEXA scan results. 5. Identify measures to maximize peak bone mass in children and adolescents. 6. Identify osteoporosis treatments available for children and adolescents. Bone consists of a collagen matrix into which calcium, in the form of hydroxyapatite, is deposited. The accumulation and maintenance of the substance of bone is the result of a continuous process of formation, predominately mediated by osteoblasts, and resorption, facilitated by osteoclasts. During childhood and adolescence, the process of formation predominates, leading to a net increase in bone mass and size. Infancy and adolescence are periods of particularly rapid formation. Peak bone mass is achieved shortly after completion of puberty and normally remains stable until the third decade of life, when age-related (involutional) bone loss begins. Osteoporosis is defined as a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fractures. It is the most common metabolic bone disorder in adults. Approximately 13.8 billion dollars were spent in 1995 in the United States for treatment of osteoporotic fractures. Osteoporosis incidence increases with age; an estimated 30% to 40% of adults older than age 60 years have osteoporosis. Genetics, age, and menopause are important, relatively unchangeable determinants of osteoporosis risk in adulthood. However, other factors, such as chronic illness, nutrition, medications, and lifestyle, clearly modify the rapidity and severity of bone loss in aging adults. Osteoporosis generally has been considered an adult disease, but there is increasing evidence that its roots lie in childhood. The loss in bone mass begins …