Primary Osteoporosis in Conditions of Pediatric Onset

Abstract

In the past, osteoporosis has been regarded as a disease of elderly women or of adults with diseases that cause progressive bone loss and fragility fractures. More recently, physicians and researchers have become aware of conditions that lead to low bone mineral density (BMD) and fractures not only in childhood and adolescence but later in life. Diseases and disorders originating in childhood but with implications for adulthood fall into two categories: primary bone and joint diseases and secondary bone diseases. This chapter will focus on primary osteoporosis, particularly osteogenesis imperfecta, as well as one condition with direct effects on joints and indirect effects on bone, specifically juvenile idiopathic arthritis. Other childhood diseases—spina bifida and the eating disorders, amenorrhea, and osteoporosis that constitute the female athlete triad—are considered elsewhere in this volume. What is common to all is the fact that they have their onset in childhood, leading to osteoporosis by or before young adulthood so that by their mid-20s and mid-30s, patients have the bones of a 70–80-year-old. Compromised bone health from infancy to age 19 carries a lifetime risk of osteoporosis.