World Health Organization defines osteoporosis as the systemic skeletal disorder characterized by low bone mass and bone micro architect disorder, resulting in increased bone fragility and tendency to frequent fractures. This definition applies to adults.

However, osteoporosis may occur, at a lower frequency, in both children and adolescents. Childhood osteoporosis may appear as a fracture after minor injury, whereas in adolescents – juvenile osteoporosis, may appear as a compressive vertebral fracture and a metaphysis fracture.

Childhood osteoporosis is classified as primary (endogenous bone disorder, usually genetic etiology) and secondary.

Causes of secondary osteoporosis in children include:

•           Diseases that cause immobility such as cerebral palsy or spinal cord injury and Duchenne muscular dystrophy.

•           Inflammatory conditions such as adolescent rheumatoid arthritis, Crohn’s disease and systemic lupus erythematosus, which by means of cytokines – deregulate the cycle of bone reconstruction.

•           Long-term, high doses of oral therapy, with corticosteroids. Taking corticosteroids or agents in any form (pills, injections, inhalers) for a long time can delay bone growth in children. This increases the chances for low bone mass then. Corticosteroids are used in the treatment of diseases such as arthritis, asthma and Crohn’s disease (colitis).

•           Difficulty in development of puberty and low body weight due to causes such as Mediterranean anemia, past malignancies treated with chemotherapy and radiation, fibrocystic disease, or even neurogenic anorexia.

•           Incomplete Osteogenesis (Osteogenesis imperfecta) or osteoporosis – a genetic disorder of the connective tissue that affects collagen, an important element of the bone, condition which leads to brittleness of bone. It is a genetic condition due to inappropriate structural construction of collagen.

The clinical picture of childhood osteoporosis varies.

Common fractures are often reported with minor injury. Compressive fractures of the vertebral bodies often show symptoms of back pain, spinal deformity and height loss, but sometimes they are asymptomatic.

Causes of adolescence osteoporosis

Usually, there is no special cause. It is a rare disease, self-limiting and usually involves a previously healthy child. The pathogenesis of the disease is under investigation, and there is evidence of impaired bone reconstruction. It appears with the same frequency in both sexes, usually between the ages of 8 and 12. It sneaks in with symptoms like pain in the lumbar and lower limbs, difficulty walking, sometimes muscle weakness, knee pain as well as fractures of the lower limbs.

Examination method for childhood and adolescence osteoporosis

The method of choice for measuring bone density in children is the X-DXA double-energy beam absorption method.

–           Secure, fast, low-cost, ultra-low radiation method.

–           Very accurate and repeatable. There is availability of pediatric normal values based on age, race and sex.

–           It can estimate for a future fracture risk

–           It measures the inorganic salts per unit area

–           Decreased bone mass is estimated in children with already diagnosed bone frailty

–           Establishment of a special therapy plan and monitoring of interventions over time

–           Predicts peak bone mass

It’s always combined with a complete clinical and laboratory investigation of the young patient, while a lateral x-ray of the spine has preceded it.

It should, also, be noted that DXA is an excellent tool for the study of:

–           The body’s development over time, in the context of chronic childhood illnesses

–           Response of the body to therapeutic interventions (such as a special diet, exercise, use of medicines).

–           Also, used to control body composition (fat-muscle mass). Body composition (lypometry) is not routine. Physiological values depend on gender, age and awareness stage.

Also, the greatest clinical experience in extreme weight values as in:

– Psychogenic anorexia (correlation of% fat and retrieval of menstruation, exercise and diet guidance)

– Fat (correlation of% fat with the occurrence of metabolic syndrome to early intervention in lifestyle).

In conclusion, bone health assessment aims to identify children and adolescents who can benefit from medical interventions to reduce the risk of a clinically significant fracture due to osteoporosis.

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