Osteoporosis in Children: Still a Diagnostic Challenge

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Abstract
Myriad challenges confront clinicians caring for children at risk for bone fragility. Despite the consensus that chronic illness, undernutrition, immobilization, and genetic bone disorders can compromise bone health, there is little agreement about how best to identify and treat these conditions (1–3). For adult patients, dual energy x-ray absorptiometry (DXA) is the principal diagnostic tool to assess risk of fracture, select patients for therapy, and monitor the response to intervention. In fact, bone mineral density (BMD) is sufficiently predictive of fracture risk in the elderly that DXA measurements alone have been used to establish the diagnosis of osteoporosis. A postmenopausal woman with a BMD T-score (sd scores from the mean for healthy young adults) at or below −2.5 has been classified as “osteoporotic” by World Health Organization criteria (4). However, fractures occur in many adults with normal BMD values because bone fragility is modulated by age, gender, weight, alcohol consumption, smoking history, glucocorticoid therapy, and personal or family fracture history (4). Models of absolute fracture risk include both BMD values and these relevant clinical factors.