scholarly journals Bone Loss, Osteoporosis, and Fractures in Patients with Rheumatoid Arthritis: A Review

2020 ◽  
Vol 9 (10) ◽  
pp. 3361
Author(s):  
Patrice Fardellone ◽  
Emad Salawati ◽  
Laure Le Monnier ◽  
Vincent Goëb
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Bone Loss ◽  
Interleukin 1 ◽  
Bone Destruction ◽  
Fragility Fractures ◽  
Systemic Effect ◽  
Vertebral Fracture Assessment ◽  
Mineral Density ◽  
Accurate Treatment

Rheumatoid arthritis (RA) is often characterized by bone loss and fragility fractures and is a frequent comorbidity. Compared with a matched population, RA patients with fractures have more common risk factors of osteoporosis and fragility fractures but also risk factors resulting from the disease itself such as duration, intensity of the inflammation and disability, and cachexia. The inflammatory reaction in the synovium results in the production of numerous cytokines (interleukin-1, interleukin-6, tumor necrosis factor) that activate osteoclasts and mediate cartilage and bone destruction of the joints, but also have a systemic effect leading to generalized bone loss. Regular bone mineral density (BMD) measurement, fracture risk assessment using tools such as the FRAX algorithm, and vertebral fracture assessment (VFA) should be performed for early detection of osteoporosis and accurate treatment in RA patients.

scholarly journals Prevalence and risk factors for bone loss in rheumatoid arthritis patients from South China: modeled by three methods

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Zhuoran Hu ◽  
Lei Zhang ◽  
Zhiming Lin ◽  
Changlin Zhao ◽  
Shuiming Xu ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Lumbar Spine ◽  
Bone Loss ◽  
South China ◽  
Serum Vitamin ◽  
Tumor Necrosis Factor Inhibitor ◽  
Healthy Controls ◽  
Mineral Density ◽  
Serum Vitamin D

Abstract Background To explore the prevalence of bone loss among patients with rheumatoid arthritis (RA) and healthy controls (HC) and further explored the risk factors for osteopenia and osteoporosis of RA patients. Methods A cross-sectional survey was undertaken in four hospitals in different districts in South China to reveal the prevalence of bone loss in patients. Case records, laboratory tests, and bone mineral density (BMD) results of patients were collected. Traditional multivariable logistic regression analysis and two machine learning methods, including least absolute shrinkage selection operator (LASSO) and random forest (RF) were for exploring the risk factors for osteopenia or osteoporosis in RA patients. Results Four hundred five patients with RA and 198 HC were included. RA patients had lower BMD in almost BMD measurement sites than healthy controls; the decline of lumbar spine BMD was earlier than HC. RA patients were more likely to comorbid with osteopenia and osteoporosis (p for trend < 0.001) in the lumbar spine than HC. Higher serum 25-hydroxyvitamin D3 level and using tumor necrosis factor inhibitor in the last year were protective factors; aging, lower body mass index, and increased serum uric acid might be risk factors for bone loss. Conclusions RA patients were more prone and earlier to have bone loss than HC. More attention should be paid to measuring BMD in RA patients aging with lower BMI or hyperuricemia. Besides, serum vitamin D and all three measurement sites are recommended to check routinely. TNFi usage in the last year might benefit bone mass.

scholarly journals P129 Predictors of low bone mineral density in rheumatoid arthritis

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Malika A Swar ◽  
Marwan Bukhari
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Bone Mineral Density ◽  
Family History ◽  
Bone Loss ◽  
Femoral Neck ◽  
Bone Mineral ◽  
Fragility Fracture ◽  
Mineral Density ◽  
History Of

Abstract Background/Aims  Osteoporosis (OP) is an extra-articular manifestation of rheumatoid arthritis (RA) that leads to increased fracture susceptibility due to a variety of reasons including immobility and cytokine driven bone loss. Bone loss in other populations has well documented risk factors. It is unknown whether bone loss in RA predominantly affects the femoral neck or the spine. This study aimed to identify independent predictors of low bone mineral density (BMD) in patients RA at the lumbar spine and the femoral neck. Methods  This was a retrospective observational cohort study using patients with Rheumatoid arthritis attending for a regional dual X-ray absorptiometry (DEXA) scan at the Royal Lancaster Infirmary between 2004 and 2014. BMD in L1-L4 in the spine and in the femoral neck were recorded. The risk factors investigated were steroid use, family history of osteoporosis, smoking, alcohol abuse, BMI, gender, previous fragility fracture, number of FRAX(tm) risk factors and age. Univariate and Multivariate regression analysis models were fitted to explore bone loss at these sites using BMD in g/cm2 as a dependant variable. . Results  1,527 patients were included in the analysis, 1,207 (79%) were female. Mean age was 64.34 years (SD11.6). mean BMI was 27.32kg/cm2 (SD 5.570) 858 (56.2%) had some steroid exposure . 169(11.1%) had family history of osteoporosis. fragility fracture history found in 406 (26.6%). 621 (40.7%) were current or ex smokers . There was a median of 3 OP risk factors (IQR 1,3) The performance of the models is shown in table one below. Different risk factors appeared to influence the BMD at different sites and the cumulative risk factors influenced BMD in the spine. None of the traditional risk factors predicted poor bone loss well in this cohort. P129 Table 1:result of the regression modelsCharacteristicB femoral neck95% CIpB spine95%CIpAge at scan-0.004-0.005,-0.003&lt;0.01-0.0005-0.002,0.00050.292Sex-0.094-0.113,-0.075&lt;0.01-0.101-0.129,-0.072&lt;0.01BMI (mg/m2)0.0080.008,0.0101&lt;0.010.01130.019,0.013&lt;0.01Fragility fracture-0.024-0.055,0.0060.12-0.0138-0.060,0.0320.559Smoking0.007-0.022,0.0350.650.0286-0.015,0.0720.20Alcohol0.011-0.033,0.0 5560.620.0544-0.013,0.1120.11Family history of OP0.012-0.021,0.0450.470.0158-0.034,0.0650.53Number of risk factors-0.015-0.039,0.0080.21-0.039-0.075,-0.0030.03steroids0.004-0.023,0.0320.030.027-0.015,0.0690.21 Conclusion  This study has shown that predictors of low BMD in the spine and hip are different and less influential than expected in this cohort with RA . As the FRAX(tm) tool only uses the femoral neck, this might underestimate the fracture risk in this population. Further work looking at individual areas is ongoing. Disclosure  M.A. Swar: None. M. Bukhari: None.

scholarly journals Iridoid Glycosides From Morinda Officinalis F. C. How Alleviate Rheumatoid Arthritis and Its Associated Bone Deterioration and Protect Against Methotrexate-induced Toxicity in Collagen-induced Arthritic Rats

2020 ◽  
Author(s):  
Yi Shen ◽  
Yu-qiong He ◽  
Qi Zhang ◽  
Jian-hua Zhang ◽  
Meng-qin Liu ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Loss ◽  
Iridoid Glycosides ◽  
Bone Destruction ◽  
Glutamate Metabolism ◽  
Mineral Density ◽  
Tissue Proliferation ◽  
Knowing That ◽  
Clinical Arthritis ◽  
Analgesic Activities

Abstract Background: Morinda officinalis F.C.How (MO), also known as “Ba-Ji-Tian” in Chinese, has long been used to treat osteoporosis and rheumatoid arthritis (RA) in China, knowing that iridoid glycosides (IG) isolated from this plant possess anti-inflammatory, anti-osteoporotic and analgesic activities. The study was to evaluate the ameliorating effect of MOIG on joint swelling and bone destruction and the protective effect against MTX toxicities.Methods: The anti-arthritic activity of MOIG was investigated by clinical arthritis scoring, paw swelling inspection, as well as histological analysis in CIA rats. The anti-bone loss activity of MOIG was evaluated by bone mineral density (BMD) and bone morphometric analysis assessed by Micro-CT and biochemical parameters in serum related with bone metabolism. The serum metabolomics and NF-κB signaling pathway were used to explore and clarify the action mechanism.Results: The results showed that MOIG was able to alleviate the paw swelling and arthritic severity, and reduce the synovial tissue proliferation and inflammatory cell infiltration in the CIA rats. In addition, MOIG decreased bone loss and improved the micro-structure of the bone trabecular in CIA rats through regulating bone formation and bone resorption. MOIG could also reduce effectively protect against MTX-induced damage to the liver, lung and stomach. The result of metabolomics analysis showed that MOIG was involved in the regulation of D-glutamine and D-glutamate metabolism, taurine and hypotaurine metabolism, valine, leucine and isoleucine biosynthesis, and alanine, aspartate and glutamate metabolism. Furthermore, MOIG inhibited OC formation and differentiation through participating in LPS-induced NF-κB signaling. Conclusion: MOIG could attenuate the paw swelling and bone loss through regulation of amino acid metabolism, reduce the side effects caused by MTX, and may serve as a novel therapeutic for the management of patients with rheumatoid arthritis (RA).

scholarly journals Prevalence and Risk Factors for Bone Loss in Rheumatoid Arthritis Patients from South China: modeled by three methods

2021 ◽  
Author(s):  
Zhuoran Hu ◽  
Lei Zhang ◽  
Zhiming Lin ◽  
Changlin Zhao ◽  
Shuiming Xu ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Lumbar Spine ◽  
Bone Loss ◽  
South China ◽  
Serum Vitamin ◽  
Tumor Necrosis Factor Inhibitor ◽  
Healthy Controls ◽  
Mineral Density ◽  
Serum Vitamin D

Abstract Background. To explore the prevalence of bone loss among patients with rheumatoid arthritis and healthy controls and further explored the risk factors for osteopenia and osteoporosis of RA patients. Methods. A cross-sectional survey was undertaken in four hospitals in different districts in South China. Case records, laboratory tests, and bone mineral density (BMD) results were included. Multivariable logistic regression analysis, least absolute shrinkage, selection operator (LASSO), and random forest (RF) was for exploring the risk factors for osteopenia or osteoporosis in RA patients.Results. Four hundred five patients with RA and 198 HC were included. RA patients had lower BMD in almost detective sites than healthy controls; the decline of lumbar spine BMD was earlier than HC. RA patients were more likely to comorbid with osteopenia and osteoporosis (p for trend <0.001) in the lumbar spine than HC. Higher serum 25-hydroxyvitamin D3 level and using tumor necrosis factor inhibitor in the last year, aging, lower body mass index, and increased serum uric acid were associated with bone loss.Conclusions. RA patients were more prone and earlier to have bone loss than HC. More attention should be paid to measuring BMD in RA patients aging with lower BMI or hyperuricemia. Besides, serum vitamin D and all three detective sites are recommended to check routinely. TNFi usage in the last year might benefit bone mass.

scholarly journals AB0611 OSTEOPOROSIS IN RHEUMATOID ARTHRITIS: A NECESSARY EVIL?

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1341.1-1341
Author(s):  
S. Athimni ◽  
S. Bouden ◽  
A. Ben Tekaya ◽  
A. Dghais ◽  
O. Saidane ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Bone Loss ◽  
Sex Ratio ◽  
Biological Treatment ◽  
Protective Factor ◽  
Local Population ◽  
Advanced Age ◽  
Mineral Density ◽  
The Mean

Background:Rheumatoid arthritis (RA) is a chronic inflammatory disease that is characterized by local and general bone loss. Osteoporosis (OP) is one of the most frequent comorbidities associated with RA. Many factors are incriminated in bone loss in RA such as inflammation, glucocorticoid (GC) use, and immobility.Objectives:-To determine the prevalence of OP in a population of actual RA patients.-To determine the risk factors of bone mineral density (BMD) reductionMethods:One hundred-fifty-two RA followed in the rheumatology department between 2015-2020 were enrolled in the study. The diagnosis of RA was established according to the American College of rheumatology/European League Against Rheumatism (ACR/EULAR) criteria 2010. BMD in lumbar spine and total hip was systematically measured in the recruited patients. Measures were taken with dual-energy x-ray absorptiometry (DEXA), and age-specific values were compared with pooled values from a local population of healthy subjects free from earlier fractures.Results:The mean age was 42.7±13 years. The sex ratio M/F was 0.24. The mean onset disease was 6±1.8 years. Fifty-sex patients (36.3%) were receiving conventional treatment DMARDs and 96 (63.6%) were under biological treatment. 35.5% were taken steroids with mean doses at 7.7±3.3mg/day. RF and ACPA were positive respectively in 87.3% and 82.4% of the patients. The mean disease activity score DAS28CRP was 4.8 ±2.7.Sixty-eight point eight 68.8% of the RA population had bone loss: 37.5% had osteopenia and 31.3% had OP. Regarding the OP group, sex ratio M/F was 0.45. The mean age was 42±5.3 years. Among the 31 women, 77.4% had postmenopausal OP. The BMI average was 31.18 ± 6.19 kg/m2. Fifteen patients (33.33%) had OP in the hip site and 20 patients had OP in the lumbar site (48.8%). Ten patients had both trabecular and cortical OP.Advanced age, glucocorticoid use and high DAS28CRP were independent risk factors for OP (respectively p=0.04, p=0.02 and p=0.01). Body mass index, smoking, disease duration high Health Assessment Questionnaire (HAQ) score (p=0.545) and smoking (p=0.326) were not associated with high risk of OP. The biological treatment was not a protective factor in OP (p=0.972). All the population subjects were free from earlier fractures, the fractural risk estimated by dint of the mean FRAXTM score was at 1.4 ± 2.3.Conclusion:Previous studies estimated that, approximately, osteoporosis affected one-third of RA patients which is in concordance with our study. Advanced age, glucorticoid treatment and severe disease were the most common risk factor in our study.Disclosure of Interests:None declared.

scholarly journals Osteoporosis in Postmenopausal Women with Breast Cancer

2020 ◽  
Vol 05 (03) ◽  
pp. 1-1
Author(s):  
Jacqueline Lamond ◽  
◽  
Charles L. Shapiro ◽  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Bone Loss ◽  
Postmenopausal Women ◽  
Osteoporotic Fracture ◽  
Fragility Fractures ◽  
Osteoporosis Prevention ◽  
Mineral Density ◽  
Cancer Treatments ◽  
The Mean

Breast cancer and osteoporosis are both diseases of aging. The "one in eight" lifetime risks of breast cancer occur primarily in the sixth, seventh, eighth, and ninth decades of life. One-third of postmenopausal women will experience an osteoporotic fracture. It is the coalescence of osteoporosis, breast cancer, and breast cancer treatments that, in some cases, increases the risks of osteoporotic fracture. That makes it imperative to assess risk factors, screen, and prevent or treat osteoporosis in postmenopausal women with breast cancer. Osteoporosis is primarily a genetic disease with a few modifiable risk factors. These risk factors include greater than two to three alcoholic drinks per day, current smoking, and decreased physical activity. The standard screening tool for osteoporosis is dual-energy x-ray absorptiometry (DXA) that gives a readout of T-scores of the lumbar spine, total hip, and femoral neck. The T-score is the number of standard deviations (SD) above or below the mean bone mineral density (BMD) of an average young adult of the same sex. For every SD below the mean BMD, the fracture risks double. Osteoporosis prevention and treatment do not differ in women with or without breast cancer. The difference is in breast cancer treatments, such as aromatase inhibitors (AI), which cause two to three-fold higher bone loss than average postmenopausal bone loss. Two classes of drugs for osteoporosis are oral and intravenous (iv) bisphosphonates and the receptor activator of nuclear factor kappa B ligand (RANKL) ligand inhibitor, subcutaneous (sc) denosumab. All three prevent bone loss and reduce the likelihood of fragility fractures. The treatment choice depends upon patient and provider preferences, specific contraindications (e.g., renal insufficiency), compliance, and costs. Despite guidelines and algorithms for AI-induced bone loss, the screening and treatment of osteoporosis remain suboptimal in postmenopausal women with breast cancer.

scholarly journals Risk factors associated with bone loss and occurrence of fragility fractures in rheumatoid arthritis patients

2019 ◽  
Vol 41 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Hamdi Wafa ◽  
Alaya Raja ◽  
Kaffel Dhia ◽  
Boughanmi Nada ◽  
Zouche Imene ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Bone Loss ◽  
Fragility Fractures ◽  
Factors Associated

scholarly journals Osteoporosis in Postmenopausal Women with Breast Cancer

2020 ◽  
Vol 05 (02) ◽  
pp. 1-1
Author(s):  
Jacqueline Lamond ◽  
◽  
Charles L. Shapiro ◽  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Bone Loss ◽  
Postmenopausal Women ◽  
Osteoporotic Fracture ◽  
Fragility Fractures ◽  
Osteoporosis Prevention ◽  
Mineral Density ◽  
Cancer Treatments ◽  
The Mean

Breast cancer and osteoporosis are both diseases of aging. The "one in eight" lifetime risks of breast cancer occur primarily in the sixth, seventh, eighth, and ninth decades of life. One-third of postmenopausal women will experience an osteoporotic fracture. It is the coalescence of osteoporosis, breast cancer, and breast cancer treatments that, in some cases, increases the risks of osteoporotic fracture. That makes it imperative to assess risk factors, screen, and prevent or treat osteoporosis in postmenopausal women with breast cancer. Osteoporosis is primarily a genetic disease with a few modifiable risk factors. These risk factors include greater than two to three alcoholic drinks per day, current smoking, and decreased physical activity. The standard screening tool for osteoporosis is dual-energy x-ray absorptiometry (DXA) that gives a readout of T-scores of the lumbar spine, total hip, and femoral neck. The T-score is the number of standard deviations (SD) above or below the mean bone mineral density (BMD) of an average young adult of the same sex. For every SD below the mean BMD, the fracture risks double. Osteoporosis prevention and treatment do not differ in women with or without breast cancer. The difference is in breast cancer treatments, such as aromatase inhibitors (AI), which cause two to three-fold higher bone loss than average postmenopausal bone loss. Two classes of drugs for osteoporosis are oral and intravenous (iv) bisphosphonates and the receptor activator of nuclear factor kappa B ligand (RANKL) ligand inhibitor, subcutaneous (sc) denosumab. All three prevent bone loss and reduce the likelihood of fragility fractures. The treatment choice depends upon patient and provider preferences, specific contraindications (e.g., renal insufficiency), compliance, and costs. Despite guidelines and algorithms for AI-induced bone loss, the screening and treatment of osteoporosis remain suboptimal in postmenopausal women with breast cancer.

scholarly journals OP0300 A CROSS-SECTIONAL, MATCHED-PAIR ANALYSIS OF ACPA POSITIVE AND ACPA NEGATIVE RHEUMATOID ARTHRITIS PATIENTS COMPARING THE PREVALENCE OF OSTEOPOROSIS, FRAGILITY FRACTURES AND UNDERLYING RISK FACTORS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 186.1-187
Author(s):  
E. Wiebe ◽  
D. Freier ◽  
D. Huscher ◽  
G. Dallagiacoma ◽  
R. Biesen ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Bone Loss ◽  
Disease Activity ◽  
Fragility Fractures ◽  
Matched Pair ◽  
Cross Sectional ◽  
Matched Pair Analysis ◽  
Sectional Analysis ◽  
Prevalence Of Osteoporosis

Background:Rheumatoid arthritis (RA) is associated with increased systemic bone loss, leading to a high risk for fragility fractures. Especially anti-citrullinated protein antibody (ACPA) positivity is considered a risk factor for local bone erosions and systemic bone loss1.Objectives:The purpose of this study was to compare ACPA positive versus ACPA negative RA patients in terms of the prevalence of osteoporosis and fragility fractures and to identify differences in underlying risk factors that influence bone health.Methods:Rh-GIOP is an ongoing prospective observational study collecting and analyzing disease- and bone-related data from patients with chronic rheumatic diseases or psoriasis treated with glucocorticoids (GC). In this cross-sectional analysis, we performed a matched-pair analysis, matching 114 ACPA positive to 114 ACPA negative RA patients according to age (5-year-steps), sex, and body mass index (BMI, 2-unit-steps). Descriptive analyses were performed, with values displayed as mean ± standard deviation for continuous variables. Non-parametric tests were used at a two-sided significance level of 5% to compare differences in underlying and potential risk factors without adjustment for multiple testing.Results:At same mean age (63.9 ±10.2 years) and BMI (27.9 ±5.6kg/m2), the matched groups had a female proportion of 82.5%. APCA positive patients had a significantly longer mean disease duration (13.9 vs 9.9 years, p<0.001), a higher mean cumulative GC-dose (22.3 vs 13.2g, p<0.01) and mean duration of GC therapy (10.1 vs 6.6 years, p<0.01). There was no significant difference in the prevalence of osteoporosis as defined by dual-energy X-ray absorptiometry (DXA) (18.4 vs 20.2%), nor in the prevalence of vertebral (7.0 vs 5.3%) or non-vertebral fractures (31.6 vs 29.8%). C-reactive protein levels as a marker of disease activity were significantly higher in ACPA positive patients (mean: 8.8 vs 4.3mg/l, p= 0.02), while mean disease activity score (DAS)28 levels were slightly lower in ACPA positive patients (2.4 vs 2.7, p= 0.05). No difference in health assessment questionnaire (HAQ) score was found. RA-specific treatments were similar, especially concerning current mean daily GC-dose (6.7 vs 4.9mg/day), except for Rituximab and targeted synthetic disease modifying anti-rheumatic drugs (DMARDs) which were more commonly used in ACPA positive patients (9.6 vs 2.6%, p=0.05) and (5.3 vs 0%, p=0.029), respectively. ACPA positive patients did not differ significantly from ACPA negative patients in specific anti-osteoporotic treatment, nor in the prevalence of comorbidities or concomitant medication. There were no significant differences in bone-specific laboratory parameters.Conclusion:In a cross-sectional analysis of our cohort, the prevalence of osteoporosis and fragility fractures was similar between ACPA positive and ACPA negative RA patients, despite longer disease duration and GC-treatment in ACPA positive patients. This is remarkable since it implies that ACPA negative patients are at a similar risk for osteoporosis and associated fractures. Optimal management of disease activity with or without GCs may represent a mainstay in preventing disease-related comorbidities such as osteoporosis.References:[1]Steffen, U., Schett, G., & Bozec, A. (2019). How Autoantibodies Regulate Osteoclast Induced Bone Loss in Rheumatoid Arthritis. Frontiers in immunology, 10, 1483. doi:10.3389/fimmu.2019.01483Disclosure of Interests:Edgar Wiebe: None declared, Desiree Freier: None declared, Dörte Huscher: None declared, gloria dallagiacoma: None declared, Robert Biesen: None declared, Sandra Hermann: None declared, Gerd Rüdiger Burmester Consultant of: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Speakers bureau: AbbVie Inc, Eli Lilly, Gilead, Janssen, Merck, Roche, Pfizer, and UCB Pharma, Frank Buttgereit Grant/research support from: Amgen, BMS, Celgene, Generic Assays, GSK, Hexal, Horizon, Lilly, medac, Mundipharma, Novartis, Pfizer, Roche, and Sanofi.

scholarly journals Management of primary and secondary osteoporosis in children

2020 ◽  
Vol 12 ◽  
pp. 1759720X2096926
Author(s):  
Sophia D. Sakka ◽  
Moira S. Cheung
Keyword(s):  
Bone Fractures ◽  
Bone Biopsy ◽  
Treatment Options ◽  
Quantitative Computed Tomography ◽  
Fragility Fractures ◽  
Secondary Osteoporosis ◽  
Long Bone ◽  
Vertebral Fracture Assessment ◽  
Primary Osteoporosis ◽  
Mineral Density

Osteoporosis in children differs from adults in terms of definition, diagnosis, monitoring and treatment options. Primary osteoporosis comprises primarily of osteogenesis imperfecta (OI), but there are significant other causes of bone fragility in children that require treatment. Secondary osteoporosis can be a result of muscle disuse, iatrogenic causes, such as steroids, chronic inflammation, delayed or arrested puberty and thalassaemia major. Investigations involve bone biochemistry, dual-energy X-ray absorptiometry scan for bone densitometry and vertebral fracture assessment, radiographic assessment of the spine and, in some cases, quantitative computed tomography (QCT) or peripheral QCT. It is important that bone mineral density (BMD) results are adjusted based on age, gender and height, in order to reflect size corrections in children. Genetics are being used increasingly for the diagnosis and classification of various cases of primary osteoporosis. Bone turnover markers are used less frequently in children, but can be helpful in monitoring treatment and transiliac bone biopsy can assist in the diagnosis of atypical cases of osteoporosis. The management of children with osteoporosis requires a multidisciplinary team of health professionals with expertise in paediatric bone disease. The prevention and treatment of fragility fractures and improvement of the quality of life of patients are important aims of a specialised service. The drugs used most commonly in children are bisphosphonates, that, with timely treatment, can give good results in improving BMD and reshaping vertebral fractures. The data regarding their effect on reducing long bone fractures are equivocal. Denosumab is being used increasingly for various conditions with mixed results. There are more drugs trialled in adults, but these are not yet licenced for children. Increasing awareness of risk factors for paediatric osteoporosis, screening and referral to a specialist team for appropriate management can lead to early detection and treatment of asymptomatic fractures and prevention of further bone damage.

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