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儿童和青少年骨质疏松症的诊断与管理

Diagnosis and Management of Osteoporosis in Children and Adolescents.

作者信息

Jin Hye Young, Noh Eu Seon, Hwang Il Tae

机构信息

Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.

出版信息

Ewha Med J. 2023 Oct;46(4):e18. doi: 10.12771/emj.2023.e18. Epub 2023 Oct 31.

Abstract

Recent advances in medicine have led to an increase in the number of children and adolescents treated for various chronic diseases and cancer. Increasingly sophisticated genetic analysis techniques have also clarified some genetic factors that contribute to bone fragility. Osteoporosis, characterized by reduced bone mass and skeletal fragility, can result from primary or secondary causes that originate in childhood and adolescence, which are critical periods for bone mineral acquisition. It is essential to identify children and adolescents at risk of fractures due to osteoporosis, and early intervention is crucial. Conservative management strategies, such as treating underlying diseases, replacing deficient hormones, providing nutritional support to meet calcium and vitamin D requirements, and encouraging regular physical activity, should be prioritized. Pharmacological treatment should be initiated in a timely manner following a comprehensive bone health examination. Intravenous pamidronate therapy has been safely and effectively administered to children and adolescents, although long-term follow-up is necessary. Further investigation is needed regarding bone fragility fractures of unknown etiology and the application of new medications for pediatric use.

摘要

医学上的最新进展使得接受各种慢性病和癌症治疗的儿童及青少年数量有所增加。日益先进的基因分析技术也已阐明了一些导致骨质脆弱的遗传因素。骨质疏松症的特征是骨量减少和骨骼脆弱,其可由童年和青少年时期的原发性或继发性病因引起,而这两个时期是骨矿物质获取的关键时期。识别出有因骨质疏松症而骨折风险的儿童和青少年至关重要,且早期干预至关重要。应优先采取保守管理策略,如治疗基础疾病、补充缺乏的激素、提供营养支持以满足钙和维生素D需求,以及鼓励定期进行体育活动。在进行全面的骨骼健康检查后,应及时开始药物治疗。静脉注射帕米膦酸盐疗法已安全有效地应用于儿童和青少年,不过仍需要长期随访。对于病因不明的脆性骨折以及儿科使用的新药应用,还需要进一步研究。

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