Osteoporosis in children

Osteoporosis in children [osteopenia, reduction of bone mineral density (BMD)] is a complex multifactorial disease with a slow asymptomatic progression until the development of bone fractures.

According to the definition adopted at the international conference in Copenhagen (1993), "osteoporosis is a systemic skeletal disease characterized by a decrease in bone mass and a violation of bone microarchyteectonics, leading to increased bone fragility and risk of fractures."

Until now, there is no single terminology regarding the pathological state of bone tissue. In the literature, the question of the possibility of diagnosing "osteoporosis" is still being discussed, if there is only a decrease in bone mass, but there are no fractures yet. In such cases, some authors recommend using the term "osteopenia", or "asymptomatic osteoporosis." Other researchers call osteopenia a decrease in the mass of bone tissue, determined instrumentally (densitometricheskim way), without taking into account the causes and nature of structural changes in the bone.

ICD-10 codes

The International Classification of Diseases of the 10th revision contains a large number of headings on osteoporosis.

The most common forms of osteoporosis, which occurs in childhood, can be attributed to the following headings:

• M81.4. Medicinal osteoporosis.
• M80.4. Medicinal osteoporosis with pathological fracture.
• M81. Osteoporosis without a pathological fracture.

Epidemiology of osteoporosis in children

Osteoporosis, according to WHO, is the fourth most important problem (diagnosis, treatment, prevention) among non-infectious diseases in adults after diseases of the cardiovascular system, oncological pathology, diabetes. This is due to its wide prevalence, multifactor nature, frequent disability, and sometimes death of patients as a result of fractures of the proximal parts of the femur.

The latest information on the incidence of osteoporosis in childhood has a wide range - from 5 to 59%. However, most domestic authors believe that the greatest frequency of reduced bone mineral density is recorded in adolescents. Epidemiology of fractures suggests that their maximum in childhood is 5-7, 13-14 years and may be due to a significant increase in body length against the background of insufficient accumulation of bone mass with age.

[1], [2], [3], [4], [5], [6],

Causes of osteoporosis in children

The disruption of bone mass accumulation in childhood can be the result of the interaction of many unfavorable factors, which can be summarized in the categories below.

What causes osteoporosis?

[7], [8], [9], [10], [11], [12], [13], [14]

What happens with osteoporosis?

Bone tissue is a dynamic system in which the processes of resorption of the old bone and the formation of a new bone, which constitutes a cycle of bone tissue remodeling, occur simultaneously throughout life.

Pathogenesis of osteoporosis

Symptoms of osteoporosis in children

In most cases, osteoporosis is asymptomatic. Complications of severe osteoporosis are fractures of tubular bones, and with glucocorticoid osteoporosis, compression fractures of the vertebrae are more common. As a result, a number of patients complain of a feeling of fatigue in the back, especially with a vertical load, pain in the thoracic or lumbar spine, which are caused by compression of the nerve roots by vertebrae deformed due to a compression fracture.

Symptoms of Osteoporosis

Classification of osteoporosis

Osteoporosis does not have a single classification, and there is also no single approach to osteoporosis in childhood. Different classifications of osteoporosis reflect the pathophysiological, morphological, etiological criteria of this disease.

Doctors in their practical work most often use the classification of osteoporosis, which is built on the etiopathogenetic principle. She suggests that osteoporosis is primary, not caused by any disease, the influence of medications, the external environment, and secondary, which includes the effects of these causes.

Classification of osteoporosis

[15], [16], [17], [18]

How is osteoporosis diagnosed?

For the biochemical evaluation of bone mineral density, the following research methods are available:

• characteristic of phosphorus-calcium metabolism;
• the definition of biochemical markers of bone remodeling.

Diagnosis of Osteoporosis

How is osteoporosis treated?

Treatment objectives:

• elimination of complaints (pain syndrome);
• prevention of bone fractures;
• slowing or stopping bone loss;
• normalization of bone metabolism;
• ensuring the normal growth of the child.

Correction of osteoporosis in childhood is complicated by the fact that unlike an adult patient with a formed bone tissue, the child still has to accumulate calcium in the bones to create in the future peak bone mass.

Treatment of osteoporosis

How to prevent osteoporosis?

In the literature there is information about the relationship between the prevention of osteoporosis in adults and the accumulation of bone mass in childhood. The authors argue that if the mineral weight of bone in childhood was reduced by 5-10%, then in old age the frequency of hip fracture increases by 25-30%. The literature cites data on the direct dependence of women's BMD on consumption in childhood and adolescence of foods rich in calcium, on the possibility of an increase in bone mass in adults by 5-10% due to the consumption of the age-related calcium in early childhood.

Prevention of osteoporosis

According to foreign authors, this is enough for a twofold reduction in the risk of fractures in later life.