Pediatric Osteoporosis Clinical Presentation

  • Author: Gordon L Klein, MD, MPH; Chief Editor: Jatinder Bhatia, MBBS   more...
 
Updated: Mar 29, 2011
 

History

Patients with reduced bone density (formerly termed osteoporosis) may be asymptomatic or may present with severe bone pain. In the peripubertal child with idiopathic juvenile osteoporosis, a gradual onset of pain occurs, primarily in the lower body (eg, hips, ankles, knees, feet), manifested by discomfort when walking.

In the elderly, severe back pain and limitation of motion may signify a vertebral compression fracture, although patients may be asymptomatic. Pain is often worse when standing and is relieved by walking. Loss of height is observed following vertebral fracture.

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Physical Examination

Children may present with spinal deformities (eg, kyphosis, kyphoscoliosis). Pigeon breast deformity, a crown-pubis/pubis-heel ratio less than 1, short stature, long bone deformities, and limping are other findings that may be observed.

In adults, loss of height and progressive kyphosis are the most prominent findings with thoracic vertebral compression fractures; lordosis or scoliosis are observed with lumbar-vertebral compression fractures.

Fractures are common, including a nondisplaced fracture in the vertebral column. Hip fractures are often observed following falls, especially in individuals who are elderly; women are more likely than men to fall on their hips.

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Contributor Information and Disclosures
Author

Gordon L Klein, MD, MPH  Senior Staff, Children's Hospital at Scott and White; Clinical Professor of Orthopedic Surgery and Rehabilitation, University of Texas Medical Branch School of Medicine

Gordon L Klein, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, American Gastroenterological Association, American Pediatric Society, American Society for Bone and Mineral Research, American Society for Clinical Nutrition, American Society for Nutritional Sciences, North American Society for Pediatric Gastroenterology and Nutrition, Sigma Xi, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Steven M Schwarz, MD, FAAP, FACN, AGAF  Professor of Pediatrics, Children's Hospital at Downstate, SUNY-Downstate Medical Center

Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research

Disclosure: Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor; Johnson & Johnson, Inc. Grant/research funds Independent contractor

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Chief Editor

Jatinder Bhatia, MBBS  Professor of Pediatrics, Chief, Section of Neonatology, Department of Pediatrics, Medical College of Georgia

Jatinder Bhatia, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Dietetic Association, American Pediatric Society, American Society for Clinical Nutrition, American Society for Parenteral and Enteral Nutrition, Society for Pediatric Research, and Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

References

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  19. [Best Evidence] Halton J, Gaboury I, Grant R, Alos N, Cummings EA, Matzinger M, et al. Advanced vertebral fracture among newly diagnosed children with acute lymphoblastic leukemia: results of the Canadian Steroid-Associated Osteoporosis in the Pediatric Population (STOPP) research program. J Bone Miner Res. Jul 2009;24(7):1326-34. [Medline].

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  26. Finkelstein JS, Hayes A, Hunzelman JL, Wyland JJ, Lee H, Neer RM. The effects of parathyroid hormone, alendronate, or both in men with osteoporosis. N Engl J Med. Sep 25 2003;349(13):1216-26. [Medline]. [Full Text].

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  29. MacKelvie KJ, Petit MA, Khan KM, Beck TJ, McKay HA. Bone mass and structure are enhanced following a 2-year randomized controlled trial of exercise in prepubertal boys. Bone. Apr 2004;34(4):755-64. [Medline].

 
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Prediction of bone loss with biochemical bone markers. Adapted from Ross PD, Knowlton W. Rapid bone loss is associated with increased levels of biochemical markers. (DPD stands for deoxypyridinoline.) J Bone Miner Res 1998 Feb; 13(2): 297-302.
 
 
 
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