Clinical practice guidelines for optimizing bone health in Korean children and adolescents

Abstract

The Committee on Pediatric Bone Health of the Korean Society of Pediatric Endocrinology has newly developed evidence-based clinical practice guidelines for optimizing bone health in Korean children and adolescents. These guidelines present recommendations based on the Grading of Recommendations, which includes the quality of evidence. In the absence of sufficient evidence, conclusions were based on expert opinion. These guidelines include processes of bone acquisition, definition, and evaluation of low bone mineral density (BMD), causes of osteoporosis, methods for optimizing bone health, and pharmacological treatments for enhancing BMD in children and adolescents. While these guidelines provide current evidence-based recommendations, further research is required to strengthen these guidelines.

Association of Insulin-like Growth Factor-1 with Bone Mineral Density in Survivors of Childhood Acute Leukemia

“…As DXA provides reliable and precise data, it is widely used in children or adolescents [8]. Moreover, DXA may be indicated when a child is considered for an intervention to decrease fracture risk [10,11]. However, DXA derives BMD by calculating only bone mass and the projected area of bone without considering bone depth, and caution should be exercised while interpreting these results with regard to children with short stature or delayed puberty [8,10,11].…”

“…Measuring bone mineral density (BMD) is the most widely used technique for monitoring bone health status [8,9]. BMD, measured using dual-energy X-ray absorptiometry (DXA) scans, is commonly used to evaluate skeletal health and define osteoporosis, which is indicated by fractures that arise with clinical significance; however, BMD alone may underestimate fracture risks [10,11]. Several factors can potentially disrupt measurements, including movement during the measurement process, scoliosis, and the presence of metalwork, all of which may complicate interpretation [8].…”

A Causality between Thyroid Function and Bone Mineral Density in Childhood: Abnormal Thyrotropin May Be Another Pediatric Predictor of Bone Fragility

“…The recently developed evidence-based consensus guidelines and recommendations for therapeutic intervention and prevention of secondary osteoporosis have pointed out that the hyperthyroidism-induced acceleration of bone turnover followed by increased cartilage maturation and bone resorption is a vital mechanism of bone loss [ 8 , 9 , 17 ]. Recent guidelines published by the Korean Thyroid Association highlighted that bone health assessment is critical in adult patients with endogenous overt hyperthyroidism or hyperthyroidism induced by TSH suppression therapy for differentiated thyroid cancer [ 18 ].…”

“…Among various causes, endocrine origins such as hypogonadism, Cushing’s syndrome, growth hormone deficiency, hyperparathyroidism, and thyroid disorders are major triggering conditions resulting in low bone mineral density (BMD) and secondary osteoporosis [ 8 ]. Both hyperthyroidism and hypothyroidism may lead to the loss of BMD by affecting the bone turnover via the dysregulation of endochondral bone formation and osteoclastogenesis [ 9 ]. Excessive levels of TH exert a direct effect on the bone resorption via the cytokine- and cycle adenosine monophosphate-mediated mechanisms, as well as the increased sensitivity of β-adrenergic receptors and bone cells to catecholamines and parathyroid hormone, respectively [ 10 ].…”

Commentary on "Long-term endocrine sequelae after hematopoietic stem cell transplantation in children and adolescents"

“…According to clinical practical guidelines for optimizing bone health in Korean children and adolescents, sufficient intake of calcium and vitamin D, along with adequate body weight and physical activity, are recommended for childhood cancer survivors. Bisphosphates could also be helpful in increasing BMD [ 10 ].…”