Anabolic Therapy for the Treatment of Osteoporosis in Childhood
Purpose of Review
Numerous forms of osteoporosis in childhood are characterized by low bone turnover (for example, osteoporosis due to neuromuscular disorders and glucocorticoid exposure). Anti-resorptive therapy, traditionally used to treat osteoporosis in the young, is associated with further reductions in bone turnover, raising concerns about the long-term safety and efficacy of such therapy. These observations have led to increasing interest in the role of anabolic therapy to treat pediatric osteoporosis.
While growth hormone and androgens appears to be relatively weak anabolic modulators of bone mass, emerging therapies targeting bone formation pathways (anti-transforming growth factor beta antibody and anti-sclerostin antibody) hold considerable promise. Teriparatide remains an attractive option that merits formal study for patients post-epiphyseal fusion, although it must be considered that adult studies have shown its effect is blunted when administered following bisphosphonate therapy. Mechanical stimulation of bone through whole body vibration therapy appears to be much less effective than bisphosphonate therapy for treating osteoporosis in children.
New anabolic therapies which target important pathways in skeletal metabolism merit further study in children, including their effects on fracture risk reduction and after treatment discontinuation.
KeywordsChildren Anabolic therapy Bone Fractures Growth hormone Parathyroid hormone Androgen therapy Testosterone Anti-sclerostin antibody Anti-TGF-beta antibody Whole body vibration therapy
Bone mineral content
Bone mineral density
Dual energy x-ray absorptiometry
Duchenne muscular dystrophy
Growth hormone deficiency
Osteoporosis pseudoglioma syndrome
Peripheral quantitative computed tomography
Transforming growth factor beta
Whole body vibration
Dr. Ward is supported by a Research Chair Award from the University of Ottawa.
Compliance with Ethical Standards
Conflict of Interest
Leanne Ward is participating in clinical trials with AMGEN, outside the submitted work. Frank Rauch declares no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
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