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Osteoporosis in paediatrics

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Osteoporosis is being increasingly recognised in paediatric practice as a consequence of several factors. These include the increasing complexity of chronic conditions and the associated treatments managed by paediatricians. In addition the improved care provided to children with chronic illness has led to many of them living long enough to develop osteoporosis. The availability of methods to assess bone density in children and the possibility of medical treatment has also resulted in an increased awareness of osteoporosis. Fractures as a consequence of osteoporosis can cause considerable pain and disability with a potential loss of independence for the child and significant disruption to school attendance and family life. Therefore techniques that can rapidly identify and treat children with osteoporosis will significantly reduce the impact on both the child and family.

DEFINITION

Osteoporosis is defined by the World Health Organization as a systemic skeletal disorder characterised by low bone mass and micro-architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture.1 In adult practice osteoporosis is also defined on the basis of bone density assessment using dual energy x ray absorptiometry (DXA), because such measurements have been shown to predict the risk of fractures. Here comparison of an individual’s bone density is against the peak bone mass seen in a young adult, with the T score representing the number of standard deviations (SD) from this value. Thus a T score more than 2.5 SDs below the mean is defined as osteoporosis whereas a T score between 1 and 2.5 SDs below the mean is defined as osteopenia. Although this definition was intended for the management of postmenopausal osteoporosis, it has been applied uncritically to other groups.

In addition to the fact that it would be inappropriate to compare a child’s bone density to that of a …

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