Drug Treatment of Low Bone Mass and Other Bone Conditions in Pediatric Patients

Osteoporosis may affect young individuals, albeit infrequently. In childhood, bone mass increases, reaching its peak between the second and third decades; then, after a period of stability, it gradually declines. Several conditions, including genetic disorders, chronic diseases, and some medications, can have an impact on bone homeostasis. Diagnosis in young patients is based on the criteria defined by the International Society for Clinical Densitometry (ISCD), published in 2013. High risk factors should be identified and monitored. Often simple interventions aimed to eliminate the underlying cause, to minimize the negative bone effects linked to drugs, or to increase calcium and vitamin D intake can protect bone mass. However, in selected cases, pharmacological treatment should be considered. Bisphosphonates remain the main therapeutic agent for children with significant skeletal fragility and are also useful in a large number of other bone conditions. Denosumab, an anti-RANKL antibody, could become a potential alternative treatment. Clinical trials to evaluate the long-term effects and safety of denosumab in children are ongoing.

Automated summary

Osteoporosis can affect young individuals, although it is rare. Bone mass increases during childhood and peaks between the second and third decades, then gradually declines. Various factors, such as genetic disorders, chronic illnesses, and certain medications, can impact bone health. Diagnosis in young patients is based on the criteria defined by the International Society for Clinical Densitometry (ISCD) in 2013. Identification and monitoring of high-risk factors are important. Simple interventions, such as addressing underlying causes, minimizing negative effects of medications on bone, or increasing calcium and vitamin D intake, can protect bone mass. Pharmacological treatment may be necessary in selected cases. Bisphosphonates are the main therapeutic agent for children with significant skeletal fragility and can also be used for other bone conditions. Denosumab, an anti-RANKL antibody, could be an alternative treatment option. Long-term effects and safety of denosumab in children are currently being evaluated in clinical trials.