[Osteoporosis in developmental age: diagnostic and therapeutic problems].

In children and the youth it is secondary osteoporosis (OP) rather than idiopathic one which occurs more often; its multidirectional pathogenesis is usually ascertainable. Secondary OP, mostly generalised, is diagnosed in the course of such hormonal disturbances as: primary hyperparathyroidism, hyperthyroidism, hyperadrenalocorticalism. Another group of diseases implicating OP are connective tissue pathologies: congenital (osteogenesis imperfecta, collagenopathies) and acquired (juvenile chronic arthritis). A serious problem for a paediatrician is the iatrogenic OP resulting from a long-term use of some medicines (glucocorticosteroids) or long-lasting immobilization for surgical and orthopaedic reasons, or from chronic general diseases. Osteoporosis accompanying pathological states of the skeletal and nervous systems (with paralyses and pareses) is particularly intensive and difficult for treatment. Osteoporosis in developmental age may cause disturbances in natural development of the skeleton, which leads to deformities in the skeletal system and to the formation of faulty postures. Lower body height is a frequent complication resulting from OP in children and the youth. In OP diagnostics the densitometry test is of the basic importance, the most common method is dual energy X-ray absorptiometry (DEXA) and the diagnosis criterion is the decrease of bone mineral density (BMD) greater than 2 SD. It should be taken into account also the X-ray and clinical symptoms, which are similar as those observed in adults. Osteoporosis biochemical markers, however are, less significant in children because for the most of then the reference values are not determined. The OP treatment is indispensable in developmental age and it should include pharmacological therapy and the proper diet and rehabilitation as well.