Gains in bone mass are very rapid during adolescence and peak bone mass, the most important determinant of
osteoporosis, is attained by early adulthood.
Glucocorticoids, widely used in children with
chronic illness, are known to impact bone mass and quality. In addition, disease and treatment-related factors, nutrient and
hormone deficiencies and decreased physical activity may all negatively affect bone mass accrual. Although decreased bone density is increasingly recognized in
chronically ill children, current knowledge of the epidemiology, diagnosis and optimal treatment of pediatric secondary
osteoporosis is limited. In addition to bone densitometry, biochemical and radiographic tests should be used in the diagnosis of
osteoporosis. Bone histomorphometry may be needed in selected situations. At risk children should be advised to ensure sufficient
calcium and
vitamin D intake and weight bearing physical activity. Growth and pubertal development require careful assessment because of their close correlation with bone formation. Given limited experience with
bisphosphonates, it seems prudent to target antiresorptive
therapy to those children who have developed symptomatic disease. Ideally this should be done in controlled settings. Early identification and adequate intervention, in selected cases with
bisphosphonates, is needed in order to prevent deleterious skeletal complications of
osteoporosis in
chronically ill children.