Sochett Etienne B, Mäkitie Outi
The Hospital for Sick Children, Division of Endocrinology, University of Toronto, Canada.
Ann Med. 2005;37(4):286-94. doi: 10.1080/07853890510007250.
Gains in bone mass are very rapid during adolescence and peak bone mass, the most important determinant of osteoporosis, is attained by early adulthood. Glucocorticoids, widely used in children with chronic illness, are known to impact bone mass and quality. In addition, disease and treatment-related factors, nutrient and hormone deficiencies and decreased physical activity may all negatively affect bone mass accrual. Although decreased bone density is increasingly recognized in chronically ill children, current knowledge of the epidemiology, diagnosis and optimal treatment of pediatric secondary osteoporosis is limited. In addition to bone densitometry, biochemical and radiographic tests should be used in the diagnosis of osteoporosis. Bone histomorphometry may be needed in selected situations. At risk children should be advised to ensure sufficient calcium and vitamin D intake and weight bearing physical activity. Growth and pubertal development require careful assessment because of their close correlation with bone formation. Given limited experience with bisphosphonates, it seems prudent to target antiresorptive therapy to those children who have developed symptomatic disease. Ideally this should be done in controlled settings. Early identification and adequate intervention, in selected cases with bisphosphonates, is needed in order to prevent deleterious skeletal complications of osteoporosis in chronically ill children.
青春期骨量增长非常迅速，而峰值骨量是骨质疏松症最重要的决定因素，在成年早期即可达到。糖皮质激素广泛应用于患有慢性疾病的儿童，已知其会影响骨量和骨质。此外，疾病及与治疗相关的因素、营养和激素缺乏以及身体活动减少，都可能对骨量积累产生负面影响。尽管慢性病患儿的骨密度降低越来越受到认可，但目前关于儿童继发性骨质疏松症的流行病学、诊断和最佳治疗的知识仍很有限。除骨密度测量外，生化和影像学检查也应用于骨质疏松症的诊断。在某些特定情况下可能需要进行骨组织形态计量学检查。应建议有风险的儿童确保摄入足够的钙和维生素D，并进行负重体育活动。由于生长和青春期发育与骨形成密切相关，因此需要仔细评估。鉴于双膦酸盐的经验有限，将抗吸收治疗针对那些已出现症状性疾病的儿童似乎是谨慎的做法。理想情况下，这应在可控环境中进行。在某些病例中，需要早期识别并进行充分干预，使用双膦酸盐，以预防慢性病患儿骨质疏松症的有害骨骼并发症。
