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The prevention and treatment of osteoporosis in children is an urgent problem of pediatrics and pediatric endocrinology. This is due to the need for preventive measures for the formation of adequate bone mass and bone strength, the duration of rehabilitation during the development of the disease and the occurrence of fractures, as well as the requirements for optimizing the treatment of this pathology in childhood.Bone tissue is a dynamic and constantly updated system. The main regulators of osteogenesis include trace elements (calcium, phosphorus, zinc, fluorine, etc.), vitamin D, hormones (parathyroid hormone, calcitonin, growth hormone, corticosteroids, etc.), growth factors (IRF-1, IRF-2, ERF, FRF, etc.), local bone-resorbing factors (IL-1, IL-6, TNF, PGE, etc.) and mechanical stress. Remodeling processes continue throughout life, but are most intense until 18 years of age.The most important risk factors for developing osteoporosis are a history of prematurity and / or IUGR, rickets, low intake of protein, calcium and vitamin D, weight deficiency, periods of active growth, low physical activity, endocrine diseases (diabetes mellitus, growth hormone deficiency, hypogonadism, etc.), somatic pathology (chronic diseases of the kidneys, liver, malabsorption), taking certain medications (GCS, anticonvulsants, cytostatics, etc.). Clinical manifestations of osteoporosis in children include signs of tissue calcium deficiency (trophic changes in the nails, hair and tooth enamel, paresthesia, pain in the calf muscles) and a decrease in bone mineralization (impaired posture, slowed growth, pain in the spine and large joints, pathological low-energy fractures) Measures to prevent osteoporosis in childhood include regular physical activity, a balanced diet, adequate insolation, and the identification and treatment of somatic pathology. Additional pharmacological correction is carried out in risk groups – the recommended course use of preparations containing vitamin D, calcium and other osteotropic minerals.The treatment of osteoporosis in children and adolescents is actively debated. A mandatory component of therapy are calcium salts in combination with vitamin D. The possibility of using bisphosphonates is being examined, the effect of monoclonal antibodies (denosumab), somatropin and anabolic steroids on bone metabolism is being studied. In addition, non-pharmacological methods are prescribed - orthopedic correction for fractures, exercise therapy, gymnastics, therapeutic swimming and massage.

Istotnym problemem klinicznym jest opracowanie metod diagnostycznych i terapeutycznych w Polsce, w celu prewencji złamań osteoporotycznych. Cukrzyca została uwzględniona w zaleceniach wielodyscyplinarnej grupy ekspertów, dotyczących postępowania diagnostycznego i terapeutycznego w celu zmniejszenia częstości złamań kostnych. Osteoporoza występuje często już w momencie ujawnienia się cukrzycy typu 1 i nasila się wraz z wiekiem. Głównym czynnikiem ryzyka jest niewyrównana cukrzyca. W cukrzycy typu 2 problem osteoporozy jest złożony i zależy od czynników ochronnych, takich jak insulinooporność oraz hiperinsulinizm, i resorpcyjnych, jak hiperkortyzolemia w otyłości. W obu typach cukrzycy częstość złamań jest większa niż u zdrowych osób, bowiem zależy ona od takich czynników, jak: niewyrównana cukrzyca, obecność powikłań, wolny obrót kostny, uszkodzenie mikroarchitektury kostnej. W cukrzycy jest konieczne prowadzenie badań przesiewowych za pomocą ultrasonograficznej oceny masy kostnej kości piętowej (aparat Achilles), ze względu na obecność neuropatii obwodowej i miejscowej osteoporozy. It is of major clinical importance to establish diagnostic procedures and treatment modalities in Poland to prevent osteoporotic fractures. Diabetes mellitus has been included in the multidisciplinary management guidelines to prevent bone fractures. Osteoporosis in type 1 diabetes mellitus is frequently the first symptom of bone density disorders which aggravate with age. Uncontrolled diabetes mellitus is the leading risk factor. In type 2 diabetes mellitus the etiology of osteoporosis is complex and related to protective factors such as insulin resistance and hyperinsulinism, and resorption such as hypercortisolemia in obesity. In both types of diabetes fracture rate is increased due to uncontrolled diabetes, complications, slow bone turnover and altered bone architecture. Diabetic patients should undergo screening using heel bone ultrasound (Achilles device) because of associated peripheral neuropathy and local osteoporosis.