Pediatric Tumor Management: Current and Controversial.

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Abstract

[Indexed for MEDLINE] 8. Eur J Pediatr. 2022 Jul;181(7):2549-2561. doi: 10.1007/s00431-022-04455-2. Epub 2022 Apr 6. Osteoporosis in children and adolescents: when to suspect and how to diagnose it. Ciancia S(1), van Rijn RR(2), Högler W(3), Appelman-Dijkstra NM(4), Boot AM(5), Sas TCJ(6)(7), Renes JS(6). Author information: (1)Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands. silvia.ciancia.18@gmail.com. (2)Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. (3)Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz, Austria. (4)Department of Internal Medicine, Subdivision of Endocrinology, Center for Bone Quality, Leiden University Medical Center, Leiden, The Netherlands. (5)Department of Pediatrics, Subdivision of Endocrinology, University Medical Center Groningen, Beatrix Children's Hospital, University of Groningen, Groningen, The Netherlands. (6)Department of Pediatrics, Subdivision of Endocrinology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands. (7)Diabeter, Center for Pediatric and Adult Diabetes Care and Research, Rotterdam, The Netherlands. Early recognition of osteoporosis in children and adolescents is important in order to establish an appropriate diagnosis of the underlying condition and to initiate treatment if necessary. In this review, we present the diagnostic work-up, and its pitfalls, of pediatric patients suspected of osteoporosis including a careful collection of the medical and personal history, a complete physical examination, biochemical data, molecular genetics, and imaging techniques. The most recent and relevant literature has been reviewed to offer a broad overview on the topic. Genetic and acquired pediatric bone disorders are relatively common and cause substantial morbidity. In recent years, there has been significant progress in the understanding of the genetic and molecular mechanistic basis of bone fragility and in the identification of acquired causes of osteoporosis in children. Specifically, drugs that can negatively impact bone health (e.g. steroids) and immobilization related to acute and chronic diseases (e.g. Duchenne muscular dystrophy) represent major risk factors for the development of secondary osteoporosis and therefore an indication to screen for bone mineral density and vertebral fractures. Long-term studies in children chronically treated with steroids have resulted in the development of systematic approaches to diagnose and manage pediatric osteoporosis. CONCLUSIONS: Osteoporosis in children requires consultation with and/or referral to a pediatric bone specialist. This is particularly relevant since children possess the unique ability for spontaneous and medication-assisted recovery, including reshaping of vertebral fractures. As such, pediatricians have an opportunity to improve bone mass accrual and musculoskeletal health in osteoporotic children. WHAT IS KNOWN: • Both genetic and acquired pediatric disorders can compromise bone health and predispose to fractures early in life. • The identification of children at risk of osteoporosis is essential to make a timely diagnosis and start the treatment, if necessary. WHAT IS NEW: • Pediatricians have an opportunity to improve bone mass accrual and musculoskeletal health in osteoporotic children and children at risk of osteoporosis. • We offer an extensive but concise overview about the risk factors for osteoporosis and the diagnostic work-up (and its pitfalls) of pediatric patients suspected of osteoporosis. © 2022. The Author(s). DOI: 10.1007/s00431-022-04455-2 PMCID: PMC9192469