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