Bone health and osteoporosis prevention have become areas of increasing concern for health care providers of children and adolescents. This review considers studies that examine measurement tools to evaluate bone density in a young, growing skeleton and strategies that may be employed to assist in the interpretation of this information. Also highlighted are reports that establish specific pediatric diagnoses to be associated with early bone loss.
An expert panel recently published recommendations regarding how to define osteoporosis in a child. Another report documented the high prevalence of errors that occur in pediatric densitometry reports, resulting in the misclassification of this diagnosis in children. Several technical reports explore algorithms or correction factors that can be used to avoid errors and enhance the interpretation of a bone density measurement in a growing child or adolescent. Other studies have focused on pediatric diagnoses such as cystic fibrosis and hemophilia, among others, that are associated with a low bone mass. Finally, recent studies have examined changes in bone density after treatment with glucocorticoids, bisphosphonates, or anticonvulsants, spurring on the debate whether the response of the pediatric skeleton to these agents differs from that seen in adults.
Controversy exists regarding the most accurate and safe measurement technique to evaluate bone mass and skeletal strength in a child. Refinement of current diagnostic tools will lead to an improved ability to assess both bone density and quality, and will afford insight into fracture risk in growing children and adolescents.
Children's Hospital Bone Health Program, Assistant Professor of Pediatrics, Harvard Medical School, Divisions of Adolescent/Young Adult Medicine and Endocrinology, Children's Hospital Boston, Boston, Massachusetts, USA
Correspondence to Catherine M Gordon, MD, MSc, Divisions of Adolescent Medicine and Endocrinology, Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA
Tel: 617 355 8492; fax: 617 730 0195; e-mail: Catherine.Gordon@childrens.harvard.edu
Sponsorship: Supported in part by National Institutes of Health grants RO1 HD043869 A1 and MO1-RR-2172, and Project 5-T71-MC-0000-10-S1-R0 from the Maternal and Child Health Bureau.