Pediatric Osteoporosis

Pediatric bone health is determined by genetics, diet, mobility, and exercise, but it can also be affected by medications and chronic disease. Although a diagnosis of osteoporosis may inspire thoughts of the geriatric population, some children are also vulnerable. Physicians providing care to both pediatric and adult populations should particularly note the major differences in the diagnosis and management of osteoporosis in children.

Pediatric osteoporosis is defined by the International Society for Clinical Densitometry based on 2 criteria. First is “low bone mineral content or bone mineral density.” Children with bone mineral density of 2 or more standard deviations below average measured using dual-energy x-ray absorptiometry (DXA) have “low bone mineral content.” DXA, which exposes patients to small doses of ionizing radiation, is the only current reference standard for assessing pediatric bone mineral density. A patient’s measurement is compared with standards for age, sex, and body size, and the result is reported as a Z score, with a value of less than –2.0 being abnormal. Unfortunately, variability in radiologic technique, the multidimensional growth of bone in childhood, and normative data that inadequately account for bone changes caused by puberty or chronic disease all present challenges to reproducible and accurate interpretation of DXA in pediatric patients.

The second criterion required for diagnosis of pediatric osteoporosis is “the presence of a clinically significant fracture history,” defined as at least 1 long bone fracture in the lower extremity, at least 2 long bone fractures in the upper extremity, or a vertebral compression fracture. Some physician discretion in applying this criterion is warranted, specifically in cases of concern for fragility or low trauma fractures. For example, …