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In children the diagnosis of osteoporosis in the absence of fractures is not easy. Both bone mineral density tests and biochemical markers need to be interpreted acording to age, size and pubertal development.
Increased bone turnover, reduced bone density for age and a cumulative dose of corticosteroids exceeding 5g are associated with an increased risk of fracture. A fracture "threshold" in children has not been identified, but the highest risk groups are those with a reduced bone density prior to commencing therapy, particularly children with juvenile idiopathic arthritis or following solid organ transplantation. Osteoporosis is also more likely to occur where other systemic steroid effects particulalrly growth retardation are observed.
All corticosteroids may potentiate osteoporosis but steroid complications are reduced in some studies which have prospectively evaluated deflazacort versus standard corticosteroid therapy.
Pamidronate given intravenously is effective in reducing fracture rate in children with inherited forms of osteoporosis and may be effective in corticosteroid induced osteoporosis also.
The recommendations are divided into general preventive measures, and evaluation/treatment.
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