Postmenopausal osteoporosis is the most frequent primary form of the pathology, and is due to oestrogen deficiency associated with menopause, which provokes an acceleration of bone loss due to age. In accordance with the Pediatric Official Positions of the International Society for Clinical Densitometry (ISCD), the diagnosis of osteoporosis in childhood is made on the basis of a history of one or more vertebral fragility fractures, or of a history of at least two fractures of the long bones before the age of 10, or of three or more long bone fractures before the age of 19 in the absence of local pathologies, high-energy trauma, and bone mineral density (BMD) Z-score ≤ 2.0 standard deviation (SD) at the lumbar spine or total body less head (TBLH) scans. When it is not possible to identify possible causes of bone loss and fragility fractures, this condition is referred to as juvenile idiopathic osteoporosis. It can also be secondary to leukaemia, prolonged immobilisation, or chronic inflammatory diseases or it can be due to the chronic administration of drugs such as anti-epileptics and glucocorticoids. The expression juvenile osteoporosis is commonly used to indicate a form of osteoporosis found in childhood and adolescence: this disease is mostly due to genetic mutations that can lead to quantitative or qualitative alterations in the connective tissue component of bone (as in osteogenesis imperfecta, which is also characterized by extra-skeletal alterations), or to an altered osteoblastic activity with the particular involvement of the trabecular bone (as in the autosomal dominant form caused by inappropriate activation of the Wnt-β catenin signal). It is, therefore, advisable to carefully evaluate the presence of dorso-lumbar pain, progressive loss of height, or dorsal kyphosis, which may result in alterations of the respiratory or gastrointestinal functions. Trauma due to a fall is by far the most frequent cause of fractures affecting long bones (femur, humerus, and radius), while it is more difficult to determine the cause and the exact time of fragility fractures of the vertebral body, which often go undiagnosed.ĭuring patient evaluation, there are some clinical history details that can suggest a vertebral fracture: recent trauma, prolonged use of corticosteroids, age, structural spinal deformity, loss of height > 6 cm, and a distance between the last rib and the iliac crest < 2 fingers. There are two forms of the disease: (a) primary osteoporosis, which includes juvenile, postmenopausal, and male and senile osteoporosis and (b) secondary osteoporosis, which is caused by a large number of diseases and medications.įragility fractures may occur in almost all skeletal segments, but the preferential locations are the vertebral column, the proximal ends of the femur and humerus, and the distal end of the radius (Colles fracture). Osteoporosis is a systemic skeletal disease characterized by a reduction in bone mass and qualitative skeletal changes (macro- and microarchitecture, material properties, geometry, and micro-damage) that cause an increase in bone fragility and higher fracture risk.
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