Treatment of Adolescent Osteoporosis

The diagnosis and management of osteoporosis in adolescents differ in several ways from the care of older adults. The diagnosis cannot be based upon low bone mineral density alone. The criteria for osteoporosis in a pediatric patient include a low trauma vertebral fracture or low bone density for age and a significant fracture history (2 or more long bone fractures before age 10 or 3 or more long bone fractures before age 19). Since many vertebral fractures are asymptomatic, radiographic screening is important for youth at high risk. Primary osteoporosis results from heritable disorders, whereas secondary osteoporosis is acquired as a consequence of chronic disease and the medications used for treatment. The myriad disorders linked to bone fragility share one or more common skeletal risk factors including nutritional deficits, reduced mobility, increased inflammatory cytokines, sex steroid or growth hormone deficiency, and osteotoxic drug therapy. The net result is reduced bone formation, which may be compounded by increased bone resorption. Growing children have the potential to restore bone strength if they recover from illness, whereas pharmacologic therapy may be indicated on a compassionate basis for patients with fragility fractures and limited potential to recover spontaneously. Primary care providers can play a critical role by identifying teens at risk for bone fragility, by encouraging optimal nutrition (including protein, calcium, and vitamin D) and physical activity, and by referring to physicians with expertise in pediatric osteoporosis. The goal of this chapter is to educate providers about current consensus and controversy on the use of osteoporosis drugs in adolescents.