Endocrine Abstracts

The diagnosis of osteoporosis in the context of the growing skeleton requires both the presence of low bone mass for body size and a history of low trauma fractures. The presentation of osteoporosis may predate adolescence, or less commonly arise during that period. Primary osteoporosis is typically due to osteogenesis imperfecta or idiopathic juvenile osteoporosis. Secondary osteoporosis arises as a result of a variety of conditions, most of which fall under thematic headings; inflammation; immobilization; endocrinopathy including anorexia; cancer and its therapy; thalassaemia; post-transplantation; and therapeutic interventions such as steroids and anti-convulsants. Inadequate intake of minerals and vitamin D can exacerbate the tendency to fracture and reduce response to therapeutic interventions. Osteomalacia may in some instances be confused with osteoporosis in teenagers. Multidisciplinary management remains a key strategy. Medical therapeutic interventions are currently limited to anti-resorptive therapy with bisphosphonates for osteoporosis; anabolic therapies are seldom used because of the perception that there is an increased risk of malignancy. Inherited forms of rickets require continued careful monitoring during the growth spurt, and there is the new therapeutic option of enzyme replacement therapy for children with hypophosphatasia that is likely to be of benefit in some at this age.

Declaration of interest: Conflict of Interest: I am a principal investigator and undertake consultancy for Enobia Pharma who produce an enzyme replacement therapy for hypophosphatasia and for previously forProctor and Gamble who produced risedronate.

Funding: Declaration of Funding: Funding for multicentre and UK-wide studies of bisphosphonates from P&G; funding for costs of undertaking ERT in Enobia studies. No grant numbers as such; no personal income from either.