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Diagnosis and treatment of pediatric osteoporosis

Bachrach, Laura K.

Current Opinion in Endocrinology & Diabetes and Obesity: December 2014 - Volume 21 - Issue 6 - p 454–460
doi: 10.1097/MED.0000000000000106
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Purpose of review Progress toward identifying and treating disorders of bone fragility in pediatric patients has been considerable in recent years. This article will summarize several key advances in the management of osteoporosis in children and adolescents.

Recent findings Recommendations from the 2013 pediatric Position Development Conference provide expert guidance for evaluating bone health in younger patients. The diagnosis of pediatric osteoporosis can be made in a child with low-trauma vertebral fractures or a combination of low bone mass and long bone fractures. Management of bone fragility includes optimizing nutrition, activity, and treatment of the underlying disease. Pharmacologic agents can be considered if these measures fail to prevent further bone loss or fractures. Although the efficacy and safety of several intravenous and oral bisphosphonates have been examined, there is still no consensus on the optimal drug, dose, or duration of treatment. Observational studies of children with secondary osteoporosis provide insight into risk factors for fracture or the potential for recovery.

Summary Despite advances in the diagnosis and treatment of pediatric osteoporosis, more research is needed. Randomized controlled trials of pharmacologic agents should be defined to target those identified at the highest risk by observational studies.

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Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA

Correspondence to Laura K. Bachrach, MD, Department of Pediatrics, Stanford University School of Medicine, Room H314, Stanford Medical Center, Stanford, CA 94035–5208, USA. Tel: +1 650 723 5791; e-mail:

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