Expert panel consensus recommendations for diagnosis and treatment of secondary osteoporosis in children

Abstract

Background: Osteoporosis incidence in children is increasing due to the increased survival rate of patients suffering from chronic diseases and the increased use of drugs that can damage bones. Recent changes made to the definition of childhood osteoporosis, along with the lack of guidelines or national consensuses regarding its diagnosis and treatment, have resulted in a wide variability in the approaches used to treat this disease. For these reasons, the Osteogenesis Imperfecta and Childhood Osteoporosis Working Group of the Spanish Society of Pediatric Rheumatology has sounded the need for developing guidelines to standardize clinical practice with regard to this pathology. Methods: An expert panel comprised of 6 pediatricians and 5 rheumatologists carried out a qualitative literature review and provided recommendations based on evidence, when that was available, or on their own experience. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A Delphi survey was conducted for those recommendations with an evidence level of IV or V. This survey was sent to all members of the SERPE. All recommendations that had a level of agreement higher or equal to 70% were included. Results: Fifty-one recommendations, categorized into eight sections, were obtained. Twenty-four of them presented an evidence level 4 or 5, and therefore a Delphi survey was conducted. This was submitted electronically and received a response rate of 40%. All recommendations submitted to the Delphi round obtained a level of agreement of 70% or higher and were therefore accepted. Conclusion: In summary, we present herein guidelines for the prevention, diagnosis and treatment of secondary childhood osteoporosis based on the available evidence and expert clinical experience. We believe it can serve as a useful tool that will contribute to the standardization of clinical practice for this pathology. Prophylactic measures, early diagnosis and a proper therapeutic approach are essential to improving bone health, not only in children and adolescents, but also in the adults they will become in the future.

Growth and puberty in children with juvenile idiopathic arthritis

“…As well as a reduction in BMD, evaluated by DXA, the presence of mostly asymptomatic VF has been found in more than 10% of JIA patients, especially with systemic and polyarticular onset [88]. This condition must be taken into account in the follow-up of children with JIA [89]. Fig.…”

“…Close monitoring of bone accrual is essential in JIA patients. Recently, the "Osteogenesis Imperfecta and Childhood Osteoporosis Working Group of the Spanish Society of Pediatric Rheumatology" published the guidelines for early diagnosis and treatment of osteporosis secondary to chronic conditions, including JIA [89]. Adequate nutritional vitamin D and calcium intake, exposure to sunlight on the hands, face and arms for6-8 min/ day in the summer and 30 min/day during the coldest months of the year and adequate treatment of the disease represent the cornerstones for the optimization of bone health in JIA patients.…”

“…A lumbar spine and total body less head (TBLH) DXA are recommended in JIA patients younger than 6 years in the presence of fragility fractures and in JIA patient older than6 years if not presenting rapid remission of disease in treatment with GCs. In patients treated with GCs a lateral spine x-ray is recommended at the beginning (within 6 months) of treatment and after 1 year, then every 9 to 12 months if treatment continues [89]. In patients who will receive GCs for 3 months or more, it is wise to give calcium supplementation or optimization of calcium (500-1000 mg/day) and vitamin D intake (400 IU/day), maintained for 3 months after discontinuation of GCs.…”

Osteoporose im Kindes- und Jugendalter

“…Tab. 2 [8]. Beispielhaft werden in den folgenden Absätzen häufige Ätiologien der sekundären pädiatrischen Osteoporose beschrieben.…”

Osteogenesis imperfecta and physical therapy: A review of recent trends during the COVID-19 pandemic

“…Along with medical and surgical treatment, functional training of the muscle and self-care management is bene icial to provide independence and to improve quality of life. There is a need for a standardized protocol for the treatment of OI patients (Galindo-Zavala et al, 2020). "Osteogenesis imperfecta" means imperfect bone formation.…”