Osteoporosis and bone health in children

Osteoporosis in a young patient requires specialist management. Paediatric osteoporosis can be diagnosed:

• following a vertebral fracture not related to local disease or significant trauma
• in a child or adolescent with both:
  • a clinically significant fracture history (at least two long bone fractures by 10 years, or at least three long bone fractures before 19 years), and
  • a height-adjusted Z-score of –2 or below (see here for information about Z-scores).

To interpret bone mineral density (BMD) measurements in young patients, use paediatric reference data, and the height-adjusted Z-score; do not use T-scores to assess BMD in children.

Osteoporosis in young people is usually related to a secondary cause, such as reduced mobility and chronic inflammatory disorders (eg neurodevelopmental disorders, neuromuscular disorders, disorders requiring glucocorticoid therapy). Other causes include malabsorption syndromes (eg coeliac disease, Crohn disease, cystic fibrosis), poor nutrition, anorexia nervosa, hypogonadism, malignancy and transplantation. Secondary osteoporosis is being increasingly recognised in childhood. Primary osteoporosis in children is rare, and is usually related to a genetic condition (eg Osteogenesis imperfecta).

Educate patients and carers about lifestyle measures that can optimise BMD. The principles of fracture prevention are similar to those in adults; see here. Maintaining healthy gonadal and pubertal status is also essential to optimising bone health in young people.

Bisphosphonate therapy can be used in children and adolescents with osteoporosis. Treatment should only be started by a specialist—the doses and frequency of administration differ significantly from those used in adults. The Australian Paediatric Working Group provides more detailed information about the use of bisphosphonates in young people¹.