Osteoporosis in children

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

According to the definition adopted at the international conference in Copenhagen (1993), “osteoporosis is a systemic skeletal disease characterized by decreased bone mass and deterioration of bone microarchitecture, leading to increased bone fragility and the risk of fractures.”

To date, there is no uniform terminology regarding the pathological condition of bone tissue. The literature is still discussing the possibility of diagnosing "osteoporosis" 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 bone mass determined instrumentally (by densitometric method), without taking into account the causes and nature of structural changes in the bone.

ICD-10 codes

The International Classification of Diseases, 10th revision, contains a large number of headings devoted to osteoporosis.

The most common forms of osteoporosis that occur in childhood can be classified under the following headings:

• M81.4. Drug-induced osteoporosis.
• M80.4. Drug-induced osteoporosis with pathological fracture.
• M81. Osteoporosis without pathological fracture.

Epidemiology of osteoporosis in children

Osteoporosis, according to WHO, ranks fourth in terms of the importance of the problem (diagnosis, treatment, prevention) among non-communicable diseases in adults after cardiovascular diseases, oncological pathology, and diabetes. This is explained by its widespread prevalence, multifactorial nature, frequent disability, and sometimes death of patients as a result of fractures of the proximal femur.

The latest data on the incidence of osteoporosis in childhood vary widely - from 5 to 59%. However, most Russian authors believe that the highest incidence of decreased bone mineral density is recorded in adolescents. The epidemiology of fractures indicates that their maximum in childhood occurs at 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.

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Causes of Osteoporosis in Children

Impaired bone mass accumulation in childhood may result from the interaction of many adverse factors, which can be summarized in the categories presented below.

What causes osteoporosis?

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What happens in osteoporosis?

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

Pathogenesis of osteoporosis

Symptoms of Osteoporosis in Children

In most cases, osteoporosis is asymptomatic. Complications of severe osteoporosis include fractures of tubular bones, and in glucocorticoid osteoporosis, more often compression fractures of the vertebrae. As a result, a number of patients complain of a feeling of fatigue in the back, especially with 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, nor does there exist a single approach to osteoporosis in childhood. Different classifications of osteoporosis reflect the pathophysiological, morphological, and etiological criteria of this disease.

In their practical work, doctors most often use the classification of osteoporosis, which is built on the etiopathogenetic principle. It assumes that osteoporosis can be primary, not caused by any disease, the influence of medications, the external environment, and secondary, which includes the impact of the listed reasons.

Classification of osteoporosis

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How is osteoporosis diagnosed?

The following research methods exist for biochemical assessment of bone mineral density:

• characteristics of phosphorus-calcium metabolism;
• determination of biochemical markers of bone remodeling.

Diagnosis of osteoporosis

How is osteoporosis treated?

Treatment goals:

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

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

Treatment of osteoporosis

How to prevent osteoporosis?

The literature contains information on the relationship between the prevention of osteoporosis in adults and the accumulation of bone mass in childhood. The authors claim that if the mineral mass of the bone in childhood was reduced by 5-10%, then in old age the incidence of hip fracture increases by 25-30%. The literature provides data on the direct dependence of BMD in women on the consumption of calcium-rich foods in childhood and adolescence, on the possibility of increasing the peak bone mass in adults by 5-10% due to the consumption of the age-appropriate calcium norm in early childhood.

Prevention of osteoporosis

According to foreign authors, this is sufficient to reduce the risk of fractures in later periods of life by two times.