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There are no recommendations for management secondary osteoporosis (SO) in the paediatric population. Biphosphonates (BP) represent the only available treatments but are not registered for this use in children. Our objectives were to survey the French paediatric rheumatologists on their practice in managing SO complicating systemic inflammatory diseases and to review the literature. Methods: we reviewed the literature using MEDLINE and COCHRANE databases. Were selected studies with : a paediatric population suffering from SO due to juvenile systemic lupus, juvenile arthritis, Still’s disease, dermatomyositis, connective tissue disease, and vasculitis, treated by BP, and in which the effect of the treatment (bone mineral density (BMD) and vertebral fracture (VF) ) were analysed. We also emailed a questionnaire to the mailing list of the SOFREMIP (French society of paediatric rheumatology), to survey paediatric specialists on their use of BP. Results: forty-eight physicians answered the questionnaire (28%). 83 % of them did not investigate SO at the initial diagnosis of the rheumatic disease, and 45.8% did during the follow-up only if there were symptoms of VF. Paediatricians began a treatment with BP in most cases when a fracture occurred. No severe secondary effects were notified. Forty on forty-eight physicians declared being in favour to use BP (grade >5/10). The fears raised by BP were the lack of guidelines, the possible consequences on growth and futures pregnancies. Ten studies were selected from the literature review. They showed that BP had a positive effect on BMD. Conclusion: BP are effective increasing BMD Z-score and relieving VF-related pain. Their efficacy preventing new fractures is unclear. Paediatrician are still looking for guidelines.; Il n’existe pas de recommandation encadrant le dépistage et la prise en charge de la fragilité osseuse (FO) secondaire chez l’enfant. Les seuls traitements utilisés sont les biphosphonates (BP) qui n’ont pas l’AMM en pédiatrie. L’objectif de notre travail est d’analyser les données de la littérature sur les BP dans la prise en charge de la FO secondaire aux maladies rhumatologiques et inflammatoires systémiques en pédiatrie. Cette revue de la littérature est enrichie d’une analyse des pratiques des rhumato-pédiatres, via un questionnaire. Matériel et méthodes : nous avons réalisé une revue systématique de la littérature sur MEDLINE et la COCHRANE. Ont été sélectionné les études ayant : population< 18 ans, atteinte de lupus juvénile, arthrite juvénile idiopathique, maladie de Still, dermatomyosite, connectivite ou vascularite, et ayant reçu des BP et disposant de résultats de densité minérale osseuse (Z-Score) et/ou taux d’incidence de fractures vertébrales (FV). Nous avons diffusé un questionnaire interrogeant les pratiques et le point de vue des rhumato-pédiatres sur les BP. Résultats : quarante-huit médecins ont répondu (28%). La plupart ne réalisent pas de dépistage systématique de la FO au diagnostic initial (83,3%). 45,8% dépistent ensuite seulement si l’enfant est symptomatique. Les médecins initient un traitement par BP en cas d’ostéoporose fracturaire. Aucun effet secondaire grave n’a été rapporté. 40/48 médecins se disent favorables aux BP (note>5/10). Les craintes liées aux BP sont : l’absence de recommandation, l’effet à long terme sur la croissance, et les grossesses futures. 10 études ont été sélectionnées et montrent un effet des BP sur la densité osseuse. Conclusion : les BP ont pour conséquence d’augmenter le Z-score et de soulager les douleurs liées aux FV. Leur effet sur la diminution de l’incidence des FV n’est pas démontré en raison d’un trop petit nombre d’études. Les praticiens sont en demande de recommandations sur le sujet.

Background: the study of the relationship between morphological features of back muscles and osteoporotic vertebral fracture risk seems promising, as biomechanics appears to play an important role in the occurrence of such fractures. Material and methods: this retrospective study included 89 patients originating from the STIC 1 and STIC 2 randomized controlled trials. Total cross-sectional area (CSA), fatty infiltration and pure muscle CSA of the para-spinal muscles, and total CSA of the psoas muscles were assessed on the CT-scan which had been performed upon inclusion. The number of new fractures (worsening prevalent fracture or incident fracture) occurring during follow-up was retrieved. The implication of muscle features in vertebral fracture risk within one year following treatment was assessed with univariate and multivariate logistic regressions (taking gender, age, BMI and number of prevalent fractures into account). Results: lower para-spinal muscle CSA at T6 level and psoas muscle CSA at L3 level, higher fatty infiltration of para-spinal muscles at L3 level, and lower pure muscle CSA of para-spinal muscles at L3 level predicted the risk of new fracture within a year following a symptomatic vertebral fracture (95,5% treated by vertebral augmentation) in multivariate analyses (p

International audience; Prevalence of osteoporosis, a systemic disease characterized by an impairment of bone mass, will continue to increase due to an ageing population and result in greater risks of fractures with disastrous medical and socioeconomic consequences. A better understanding of the regulation pathway of bone remodeling has led to the identification of new therapeutic targets. Denosumab, a monoclonal antibody against Receptor Activator of Nuclear factor κB-ligand (key molecule in osteoclastogenesis) is a fast-working, reversible antiresorptive treatment. A subcutaneous injection is required twice a year, a significant advantage over bisphosphonates whose efficiency is limited by an inadequate long-term compliance. The only anabolic agent currently available, Teriparatide (parathyroid hormone residues 1-34), administered daily via subcutaneous injection, stimulates both sides of bone remodeling in favour of bone formation. Anti-sclerostin antibodies neutralize an inhibitor of Wnt pathway, the master switch for osteoblastic differentiation, and meet the challenge of pioneering an anabolic drug that does not increase bone resorption. If the tolerance of these promising treatments is good in clinical trials of short duration, their implication in signaling pathways affecting various tissues means that one has to keep a very close watch on their long-term potential risks. Finally, the endocrinologists must be aware that the local regulating factors of bone remodeling recently identified (sclerostin, osteoprotegerin) seem to be the key mediators of hormones with bone tropism.

International audience; During the past decade, major advances have reported the importance of the vitamin D on the bone metabolism, and recent studies have suggested the potential non skeletal effects of the vitamin D. Adequate vitamin D contributes to reduce the risk of non vertebral fractures, improves the neuromuscular function and reduces the risk of falls when serum 25OHD level are greater than 30ng/mL (75nmol/L). A possible role of vitamin D has been implicated in the reduction of mortality, of the non-skin cancers, of the risk of infections, of inflammatory diseases, of cardiovascular diseases and maybe osteoarthritis. However the current level of evidence for associations is weaker than for skeletal effects. Serum 25OHD level is influenced by several factors (cutaneous vitamin D production, fat mass, dietary sources, UV-B exposure, latitude, season...), and the measurement of the serum 25OHD level is the only way to determine the vitamin D status. It is recommended to measure the serum 25OHD level in patients with osteoporosis or at risk of osteoporosis, and to correct the deficiency.