🦴 Chapter 749 · Osteoporosis

Nelson Textbook of Pediatrics 22nd Edition | Osteoporosis in children: defined as low bone density (DXA Z-score ≤ -2.0) + clinically significant fracture history (≥2 long bone fractures by age 10, ≥3 by age 19, or any vertebral fracture). Primary: osteogenesis imperfecta, idiopathic juvenile osteoporosis, osteogenesis imperfecta, Ehlers-Danlos, Marfan. Secondary: glucocorticoid-induced, cerebral palsy (non-ambulatory), Duchenne muscular dystrophy, anorexia nervosa, chronic disease (inflammatory bowel disease, cystic fibrosis), hypogonadism. Treatment: calcium (RDA 1300 mg/day adolescents), vitamin D (goal 25OHD >30 ng/mL), weight-bearing exercise, bisphosphonates (pamidronate, zoledronic acid) for severe or symptomatic osteoporosis.

🌐 paeds.online — Pediatric Learning Platform

📋 30 Clinical Scenarios — Osteoporosis

📇 High‑Yield Review Cards

🩺 Clinical Recognition: Osteoporosis

Select a presentation to review diagnostic clues and management per Nelson Ch 749.

📋 Stepwise Management of Pediatric Osteoporosis

🔑 Key Principles — Nelson Chapter 749
• Diagnosis: DXA Z-score ≤ -2.0 + clinically significant fracture history (≥2 long bone fractures <10y, ≥3 <19y, or any vertebral fracture).
• Primary osteoporosis: Osteogenesis imperfecta (most common), idiopathic juvenile osteoporosis (pubertal onset, self-limited), osteogenesis imperfecta, Ehlers-Danlos, Marfan, osteogenesis imperfecta.
• Secondary osteoporosis: Glucocorticoid-induced (most common), cerebral palsy (non-ambulatory), Duchenne muscular dystrophy, anorexia nervosa, hypogonadism, chronic diseases (IBD, CF, CKD, JIA), anticonvulsants.
• Treatment: Optimize calcium (RDA 1300 mg/day adolescents) and vitamin D (goal 25OHD >30 ng/mL). Weight-bearing exercise. Bisphosphonates (IV pamidronate or zoledronic acid) for severe osteoporosis (frequent fractures, vertebral compression, bone pain).
• Idiopathic juvenile osteoporosis: Presents age 8-12 years, back pain, vertebral fractures, spontaneous resolution after puberty.

    ⚡ Reflex Prompts — Clinical Decisions

    📖 Summary: Osteoporosis (Nelson 749)