eMedicine Specialties > Pediatrics: General Medicine > Nutrition

Osteoporosis: Follow-up

Author: Gordon L Klein, MD, MPH, Professor, Departments of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Texas Medical Branch
Contributor Information and Disclosures

Updated: Aug 21, 2008

Follow-up

Further Inpatient Care

  • Generally, individuals suffering from bone loss alone (formerly termed osteoporosis) do not require hospitalization unless they have a complication such as a hip fracture. This is a very uncommon occurrence in children; however, following a fracture, anticipatory intervention is needed to minimize future hospital stays and to identify individuals at risk for repeated fractures.

Further Outpatient Care

  • The aim of further outpatient care is to closely monitor bone density to determine if ongoing bone loss occurs or if the process has reached a plateau. In these situations, measurements of biochemical markers of bone formation and resorption can help guide therapy choices and duration.

Inpatient & Outpatient Medications

  • Currently, antiresorptives are the only consistently reliable medications.

Transfer

  • Transferring a patient is not necessary unless pediatric subspecialty care is unavailable at the institution.

Deterrence/Prevention

  • Prevention includes patient education and early recognition of the symptoms and signs of hypercalcemia and hypercalciuria.

Complications

  • The main complication is fractures, including a nondisplaced fracture in the vertebral column.

Prognosis

  • Prognosis depends on the underlying cause.
  • A genetic condition leading to increased bone resorption may have a satisfactory prognosis if the antiresorptive agents can eliminate further bone loss.
  • For postmenopausal or senile osteoporosis in which bone formation is reduced, prognosis is improved because of the advent of parathyroid hormone administration to adults for 1 year followed by a bisphosphonate for 1 year. This results in bone gain.
  • In the case of trauma-induced or burn-induced osteopenia in which bone formation is primarily affected, prognosis depends on the patient's genetically determined peak bone mass and efficacy of clinically experimental therapies, such as anabolic steroids and pamidronate along with correction of progressive vitamin D deficiency that is a consequence of the skin's failure to make adequate vitamin D with ultraviolet light exposure, similar to what is seen elderly persons.

Patient Education

  • Use education as a means of prevention and treatment. Instruct children, adolescents, and their families that the roots of adult-onset osteoporosis begin in childhood; therefore, ensure adequate calcium intake and weight-bearing exercises to maximize genetically determined peak bone mass.
  • As early as possible, inform patients of any age with osteopenia or osteoporosis why bone loss has occurred and how to keep bone loss under control. Also inform patients with osteopenia or osteoporosis of the consequences of bone loss.
  • For excellent patient education resources, visit eMedicine's Bone Health Center. Also, see eMedicine's patient education articles Osteoporosis and Understanding Osteoporosis Medications.

Miscellaneous

Medicolegal Pitfalls

  • Bone demineralization on DEXA does not always indicate osteoporosis. If a workup for osteopenia is not initiated, many potentially severe and disabling causes of osteopenia, such as Paget disease or bone loss secondary to an underlying disease, may be missed.

Special Concerns

  • Given the currently accepted WHO definition of osteoporosis, children appear to be an exception to the disease and, by present definition, do not develop this condition, even secondary to another chronic illness. However, given the more recent NIH definition of osteoporosis, the pediatrician may interpret this condition with sufficient latitude as to increase awareness of bone-weakening diseases and medications.
 


More on Osteoporosis

Overview: Osteoporosis
Differential Diagnoses & Workup: Osteoporosis
Treatment & Medication: Osteoporosis
Follow-up: Osteoporosis
References
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References

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  2. Gordon CM, Bachrach LK, Carpenter TO, et al. Dual energy X-ray absorptiometry interpretation and reporting in children and adolescents: the 2007 ISCD Pediatric Official Positions. J Clin Densitom. Jan-Mar 2008;11(1):43-58. [Medline].

  3. Rauch F, Plotkin H, DiMeglio L, et al. Fracture prediction and the definition of osteoporosis in children and adolescents: the ISCD 2007 Pediatric Official Positions. J Clin Densitom. Jan-Mar 2008;11(1):22-8. [Medline].

  4. Baim S, Leonard MB, Bianchi ML, et al. Official Positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Pediatric Position Development Conference. J Clin Densitom. Jan-Mar 2008;11(1):6-21. [Medline].

  5. Bishop N, Braillon P, Burnham J, Cimaz R, Davies J, Fewtrell M, et al. Dual-energy X-ray aborptiometry assessment in children and adolescents with diseases that may affect the skeleton: the 2007 ISCD Pediatric Official Positions. J Clin Densitom. Jan-Mar 2008;11(1):29-42. [Medline].

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  10. Przkora R, Herndon DN, Sherrard DJ, Chinkes DL, Klein GL. Pamidronate preserves bone mass for at least 2 years following acute administration for pediatric burn injury. Bone. Aug 2007;41(2):297-302. [Medline].

  11. Finkelstein JS, Hayes A, Hunzelman JL, et al. 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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  13. Klein GL, Chen TC, Holick MF, et al. Synthesis of vitamin D in skin after burns. Lancet. Jan 24 2004;363(9405):291-2. [Medline].

  14. Klein GL, Herndon DN, Goodman WG. Histomorphometric and biochemical characterization of bone following acute severe burns in children. Bone. Nov 1995;17(5):455-60. [Medline].

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Further Reading

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Keywords

osteoporosis, low bone mass, pediatric osteoporosis, juvenile osteoporosis, fracture, compromised bone strength, osteopenia, chronic liver disease, burn injuries, Paget disease, hyperparathyroidism, hypophosphatemic metabolic bone disease, idiopathic juvenile osteoporosis, bony deformities, cardiopulmonary compromise, reduced bone density, kyphosis, kyphoscoliosis, short stature, long bone deformities, lordosis, scoliosis, pigeon breast deformity, hip fractures, inflammatory bowel disease, rheumatoid arthritis, trauma

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Contributor Information and Disclosures

Author

Gordon L Klein, MD, MPH, Professor, Departments of Pediatric Gastroenterology, Hepatology, and Nutrition, University of Texas Medical Branch
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.

Medical Editor

Steven M Schwarz, MD, FAAP, FACN, AGAF, Professor of Pediatrics, State University of New York, Downstate Medical Center College of Medicine; Distinguished Lecturer, New York Medical College, School of Public Health
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: TAP Pharmaceuticals Honoraria Speaking and teaching; Curemark, LLC Consulting fee Board membership

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from broker recommendation; Avanir Pharma Stock Investment from broker recommendation

Managing 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 Federation for Clinical Research, American Pediatric Society, American Society for Clinical Nutrition, American Society for Parenteral and Enteral Nutrition, New York Academy of Sciences, Society for Pediatric Research, and Southern Society for Pediatric Research
Disclosure: Mead Johnson Consulting fee Consulting; Mead Johnson Honoraria Speaking and teaching; Dey LP Consulting fee Consulting; Dey LP Honoraria Speaking and teaching; Wyeth Grant/research funds Other; Med Immune Grant/research funds Other; Ovation  None

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
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 Federation for Clinical Research, American Pediatric Society, American Society for Clinical Nutrition, American Society for Parenteral and Enteral Nutrition, New York Academy of Sciences, Society for Pediatric Research, and Southern Society for Pediatric Research
Disclosure: Mead Johnson Consulting fee Consulting; Mead Johnson Honoraria Speaking and teaching; Dey LP Consulting fee Consulting; Dey LP Honoraria Speaking and teaching; Wyeth Grant/research funds Other; Med Immune Grant/research funds Other; Ovation  None

 
 
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