Bone Fragility Study in Pediatric Population With Risk Factors
Condition: Bone Loss, Age-Related
MeSH terms: Osteoporosis
Study type: Observational

Summary: 
      Low bone mass and osteoporosis are underdiagnosed in childhood in our environment and its
      prevalence is unknown. In most cases they are secondary to chronic diseases that conduct to a
      poor bone health condition and thereby a risk of fracture increased. The aim of this study is
      to identify patients with risk factors for low bone mass and determine their Bone Mineral
      Density (amount of bone) by performing bone densitometry and compared with healthy population
      of the same characteristics. Also the investigators want to evaluate bone quality by
      application of Trabecular Bone Score to images obtained by densitometry. As secondary
      objectives the investigators intend to correlate the data with with clinical variables to
      identify the most important in bone health clinical factors. In addition to measuring bone
      quality and quantity demographic and clinical process related to bone quality base and
      variables will be collected.
    

Detailed description: 
      Osteoporosis (OP) in children is a rare disease whose incidence is unknown, partly due to
      lack of diagnosis associated with the absence of specific clinical symptoms in the early
      stages of the disease.

      That is why the active recognition of this disease by the pediatrician and the pediatrician
      rheumatologist is essential to prevent future complications: fractures and comorbidity
      associated with them, including possible deformities and the need for surgical correction.

      The diagnosis of OP in children and adolescents requires the combination of densitometric
      criteria (low bone mass or deficits in mineralization) and the clinical judgment of
      clinically significant fracture. Any of the following fractures are considered clinically
      significant fractures: Long bone fracture of the lower limbs, vertebral compression fracture,
      or two or more long bone fractures of upper extremities.

      Low bone mass for age is considered when the Z-score of the measurement of bone mineral
      density (BMD) is less than or equal to -2, adjusted for age, sex and body mass index.

      The Z-score is a value that is calculated by subtracting the average patient BMD BMD their
      age group and gender and this value by dividing the standard deviation of their age group and
      gender.

      DXA (dual-energy X ray absortiometry) lumbar and whole body (excluding the head) is the
      method of choice for measuring bone mineral density (BMD), since it is the most accurate
      skeletal location and reproducible for measuring BMD.

      Juvenile Idiopathic Osteoporosis is a very rare entity, with less than 200 cases described in
      the literature, and whose diagnosis requires the exclusion of secondary forms of
      osteoporosis.

      Among the causes of osteoporosis (low bone mass or) secondary in child population the
      investigators have: kidney diseases, metabolic diseases, hematological, endocrinological,
      gastrointestinal and rheumatological, including chronic systemic disorders. The transplant
      and cancer patients have generally a multifactorial risk of osteoporosis (immobilization,
      medical treatment, etc.).

      Also, nutritional causes are another large block of secondary forms of child and / juvenile
      (or low bone mass for age) osteoporosis. Typical examples of malabsorptive disease are celiac
      disease, cystic fibrosis and chronic inflammatory bowel disease and anorexia nervosa.

      Special attention should pediatric patients treated with nonsteroidal antiinflammatory drugs,
      methotrexate and, of course, glucocorticoids, potent inducers and inhibitors of
      osteoclastogenesis osteoblastogenesis.

      Other medications that affect a greater risk of developing osteoporosis are: some
      anticonvulsants, anticoagulants and chemotherapies.

      According to the ISCD (International Society for Clinical Densitometry) should be performed
      by DXA bone densitometry as a measure of bone health assessment of all children with
      increased risk of fracture. They are therefore candidates for a bone densitometry pediatric
      patients with primary bone diseases or potential secondary bone diseases (eg, pre-transplant
      chronic inflammatory diseases, endocrine disorders, cancer or history).

      While DXA is the only validated technique today for indirect measurement of fracture risk in
      itself is only able to analyze changes in bone mineral content, so recently they have
      intensified efforts to validate other techniques possible to assess not only the quantity but
      also the quality of the bone. Among the highlights is the TBS (Trabecular Bone Score) which
      is software that applied directly to the information obtained through the spinal DXA can
      analyze the trabecular number, thickness and connectivity, providing extra information about
      the strength or weakness of the vertebra. Its use is spreading in routine clinical practice
      in the adult population as it is safe and does not increase the time required exploration,
      however in the pediatric population is not included in routine practice even though its
      application could provide additional information to the DMO on which to base treatment
      decisions.
    

Observational model: Ecologic or Community
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients under 21 years of age who are at risk of bone fragility (pediatric patients with
        primary bone diseases or potential secondary bone diseases (eg , chronic inflammatory
        diseases , endocrine disorders , history of cancer or pre- transplant) and whose parents /
        guardians have signed the informed consent