Bachrach Laura K
Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.
Curr Opin Endocrinol Diabetes Obes. 2014 Dec;21(6):454-60. doi: 10.1097/MED.0000000000000106.
Progress toward identifying and treating disorders of bone fragility in pediatric patients has been considerable in recent years. This article will summarize several key advances in the management of osteoporosis in children and adolescents.
Recommendations from the 2013 pediatric Position Development Conference provide expert guidance for evaluating bone health in younger patients. The diagnosis of pediatric osteoporosis can be made in a child with low-trauma vertebral fractures or a combination of low bone mass and long bone fractures. Management of bone fragility includes optimizing nutrition, activity, and treatment of the underlying disease. Pharmacologic agents can be considered if these measures fail to prevent further bone loss or fractures. Although the efficacy and safety of several intravenous and oral bisphosphonates have been examined, there is still no consensus on the optimal drug, dose, or duration of treatment. Observational studies of children with secondary osteoporosis provide insight into risk factors for fracture or the potential for recovery.
Despite advances in the diagnosis and treatment of pediatric osteoporosis, more research is needed. Randomized controlled trials of pharmacologic agents should be defined to target those identified at the highest risk by observational studies.
近年来，在识别和治疗儿科患者骨脆性疾病方面取得了显著进展。本文将总结儿童和青少年骨质疏松症管理方面的几个关键进展。
2013年儿科立场发展会议的建议为评估年轻患者的骨骼健康提供了专家指导。儿科骨质疏松症的诊断可基于低创伤性椎体骨折或低骨量与长骨骨折并存的儿童。骨脆性的管理包括优化营养、活动以及治疗基础疾病。如果这些措施未能预防进一步的骨质流失或骨折，则可考虑使用药物。尽管已经对几种静脉内和口服双膦酸盐的疗效和安全性进行了研究，但在最佳药物、剂量或治疗持续时间方面仍未达成共识。对继发性骨质疏松症儿童的观察性研究为骨折风险因素或恢复潜力提供了见解。
尽管儿科骨质疏松症的诊断和治疗取得了进展，但仍需要更多研究。应开展药物的随机对照试验，以针对观察性研究确定的高风险人群。
Zotero 插件