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Table 3 Assessment of BMD for certain diseases or chronic treatments involved in childhood secondary osteoporosis

From: Expert panel consensus recommendations for diagnosis and treatment of secondary osteoporosis in children

Disease / Treatment BMD assessment
Celiac disease DXA if:
-no adequate dietary adherence
-irregular menstruation
-anemia
-other risk factors for fractures [74]
Cerebral palsy Difficult lumbar spine X-ray interpretation in cases of severe scoliosis.
Total-body or distal femur DXA (area with higher fracture risk), only if there are fragility fractures [8].
Duchenne muscular dystrophy Baseline DXA and annual monitoring.
Lateral spine x-ray: Baseline
- On GCs treatment: Repeat every 1–2 years.
- Not on GCs treatment: Repeat every 2–3 years.
- If back pain or ≥ 0, 5 SD decline in spine BMD Z score on serial measurements over 12-month period: Repeat.
Refer to osteoporosis specialist following the first fracture [11].
Rett syndrome Baseline DXA, and serial controls according to individual risk [15].
Epilepsy Consider DXA for epileptic patients receiving anti-epileptic drugs for a prolonged period [13]
Thalassemia DXA every 2 years from adolescence [12]
Inflammatory/ systemic disease Consider DXA for patients receiving high doses of GCs [74].
Juvenile idiopathic arthritis (JIA) <  6 years: DXA in the presence of fragility fractures.
>  6 years: DXA if not presenting rapid remission of JIA or in need of high doses of GCs [18].
Neoplasms Baseline DXA two years after completing chemotherapy with osteotoxic drugs; e.g., MTX, GCs or hematopoietic cells transplantation; or secondary effects that favor osteoporosis development (growth hormone deficiency, hypogonadism, etc.)
DXA follow-up based on the results of baseline DXA and persistent risk factors [17]
Cystic fibrosis DXA in children ≥ age 8 if:
- weight < 90% ideal weight
- FEV1 < 50%
- Delayed puberty
- High dosis of GCs > 90 days per year
At 18, all of them [101].
Diabetes mellitus DXA if:
- low BMD specific risk factors
- increased daily insulin dosis
- impaired renal function
- fracture history [74]
Anorexia nervosa DXA in patients with amenorrhea for more than 6 months [13].
Systemic lupus erythematosus DXA evaluation in patients with prolonged systemic GCs exposure exceeding ≥0.15 mg/kg daily for ≥ 3 months. Repeat on an annual basis if Z-score ≤ − 2 [102].
  1. DXA dual-energy x-ray absorptiometry, BMD bone mineral density, GCs glucocorticoids, MTX methotrexate, FR risk factors