The medical treatment of osteoporosis in children at present mainly relies on anti-resorptive drugs, in particular bisphosphonates. However, not all forms of pediatric osteoporosis are characterized by increased bone resorption. In disorders with low bone turnover and decreased bone formation activity, such as osteoporosis due to neuromuscular disorders and glucocorticoid exposure, use of bone anabolic approaches appears to be a more logical option than antiresorptive drugs, which further suppress bone turnover. Several bone anabolic approaches to treat osteoporosis are available and can be categorized as hormone therapy, mechanical stimulation, and biologic anabolic (antibody) therapy. Treatment with growth hormone, androgens and parathyroid hormone are some of the hormonal approaches. Among mechanical therapies, whole body vibration has been tested in several conditions. Antibody-based therapies, such as inhibition of sclerostin and transforming growth factor beta, have not yet been tested in children but represent potentially the most specific approach to induce bone formation. Nevertheless, such treatments can be expected to have only a short-lived effect on bone. Long-acting osteoporosis therapy may therefore still be required.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology