Pediatria pre prax 3/2013

Glucocorticoid-induced osteoporosis in children – prevention and treatment

Prolonged glucocorticoid therapy despite it´s potent anti-inflamatory and immunosuppressive actions has been associated with a profound alteration of bone metabolism, which could lead to a steroid-induced osteoporosis. While in adults, evidence-based guidelines exist to basic management of patients with glucocorticoid-induced osteoporosis, the much less abundant data for children and adolescents with osteoporosis makes it more difficult to set clear guidelines for the pediatric population. The management of glucocorticoid-induced osteoporosis consists from a preventive regimen and pharmacological therapy. A regular physical activity and both the suplementation of calcium and vitamin D is recommended in all children receiving immunosupressive doses of corticosteroids over 6 months. Bisphosphonate treatment may be considered for patients with symptomatic osteoporosis (bone pain, the recurrent fractures and vertebral compression) and children who failed to respond adequately to the general preventive measures. Pharmacotherapy should be managed by a specialist with knowledge of the skeletal disorders in childhood.

Keywords: osteoporosis, glucocorticoids, calcium, vitamin D, bisphosphonates.