Abstract
Skeletal complaints are seen commonly in pediatric primary care, most of which do not represent endocrine disease. Endocrine-mediated skeletal disease is thankfully rare; however, pediatricians should be aware that low bone mineral density and fracture secondary to chronic medical conditions are both on the rise due to longer survival and enhanced treatment options for chronically ill children. Here, we review key elements of the history, physical examination, and basic laboratory evaluation to guide a general pediatrician in the initial evaluation of skeletal health until a child can be evaluated by a pediatric endocrinologist.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsAbbreviations
- BMD:
-
Bone mineral density
- DXA:
-
Dual-energy X-ray absorptiometry
- OI:
-
Osteogenesis imperfecta
- PTH:
-
Parathyroid hormone
- SHOX:
-
Short stature homeobox-containing gene
References
Lifshitz F. Pediatric endocrinology. 5th ed. New York: Informa Healthcare; 2007.
Clarke B. Normal bone anatomy and physiology. Clin J Am Soc Nephrol. 2008;3(Suppl 3):S131–9.
Hilton CMKMJ. Endochondral ossification. In: Primer on the metabolic bone diseases and disorders of mineral metabolism. Wiley, Hoboken, New Jersey. p. 12–9.
Danseco ER, Miller TR, Spicer RS. Incidence and costs of 1987-1994 childhood injuries: demographic breakdowns. Pediatrics. 2000;105(2):E27.
Weber DR, Boyce A, Gordon C, Hogler W, Kecskemethy HH, Misra M, et al. The utility of DXA assessment at the forearm, proximal femur, and lateral distal femur, and vertebral fracture assessment in the pediatric population: 2019 ISCD official position. J Clin Densitom. 2019;22(4):567–89.
Wheeler BJ, Snoddy AME, Munns C, Simm P, Siafarikas A, Jefferies C. A brief history of nutritional rickets. Front Endocrinol (Lausanne). 2019;10:795.
Carpenter TO, Shaw NJ, Portale AA, Ward LM, Abrams SA, Pettifor JM. Rickets. Nat Rev Dis Primers. 2017;3:17101.
Gonzalez Ballesteros LF, Ma NS, Gordon RJ, Ward L, Backeljauw P, Wasserman H, et al. Unexpected widespread hypophosphatemia and bone disease associated with elemental formula use in infants and children. Bone. 2017;97:287–92.
Chalouhi C, Nicolas N, Vegas N, Matczak S, El Jurdi H, Boddaert N, et al. Scurvy: a new old cause of skeletal pain in young children. Front Pediatr. 2020;8:8.
Faienza MF, Ventura A, Colucci S, Cavallo L, Grano M, Brunetti G. Bone fragility in Turner syndrome: mechanisms and prevention strategies. Front Endocrinol (Lausanne). 2016;7:34.
Turner J, Pellerin G, Mager D. Prevalence of metabolic bone disease in children with celiac disease is independent of symptoms at diagnosis. J Pediatr Gastroenterol Nutr. 2009;49(5):589–93.
Shaker JL, Brickner RC, Findling JW, Kelly TM, Rapp R, Rizk G, et al. Hypocalcemia and skeletal disease as presenting features of celiac disease. Arch Intern Med. 1997;157(9):1013–6.
Sarinho ESC, Melo V. Glucocorticoid-induced bone disease: mechanisms and importance in pediatric practice. Rev Paul Pediatr. 2017;35(2):207–15.
Lee CT, Chen HC, Lai LW, Yong KC, Lien YH. Effects of furosemide on renal calcium handling. Am J Physiol Renal Physiol. 2007;293(4):F1231–7.
Barstow C, Rerucha C. Evaluation of short and tall stature in children. Am Fam Physician. 2015;92(1):43–50.
Gilsanz V, Chalfant J, Kalkwarf H, Zemel B, Lappe J, Oberfield S, et al. Age at onset of puberty predicts bone mass in young adulthood. J Pediatr. 2011;158(1):100–5, 5 e1-2.
el-Hajj Fuleihan G, Klerman EB, Brown EN, Choe Y, Brown EM, Czeisler CA. The parathyroid hormone circadian rhythm is truly endogenous--a general clinical research center study. J Clin Endocrinol Metab. 1997;82(1):281–6.
Trivedi H, Szabo A, Zhao S, Cantor T, Raff H. Circadian variation of mineral and bone parameters in end-stage renal disease. J Nephrol. 2015;28(3):351–9.
Turan S, Topcu B, Gokce I, Guran T, Atay Z, Omar A, et al. Serum alkaline phosphatase levels in healthy children and evaluation of alkaline phosphatase z-scores in different types of rickets. J Clin Res Pediatr Endocrinol. 2011;3(1):7–11.
Schiele F, Henny J, Hitz J, Petitclerc C, Gueguen R, Siest G. Total bone and liver alkaline phosphatases in plasma: biological variations and reference limits. Clin Chem. 1983;29(4):634–41.
Manz F, Kehrt R, Lausen B, Merkel A. Urinary calcium excretion in healthy children and adolescents. Pediatr Nephrol. 1999;13(9):894–9.
Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011;96(7):1911–30.
Chesney RW, Zimmerman J, Hamstra A, DeLuca HF, Mazees RB. Vitamin D metabolite concentrations in vitamin D deficiency. Are calcitriol levels normal. Am J Dis Child. 1981;135(11):1025–8.
Lund B, Clausen N, Lund B, Andersen E, Sorensen OH. Age-dependent variations in serum 1,25-dihydroxyvitamin D in childhood. Acta Endocrinol. 1980;94(3):426–9.
Zemel BS, Stallings VA, Leonard MB, Paulhamus DR, Kecskemethy HH, Harcke HT, et al. Revised pediatric reference data for the lateral distal femur measured by Hologic Discovery/Delphi dual-energy X-ray absorptiometry. J Clin Densitom. 2009;12(2):207–18.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Renthal, N.E. (2021). Skeletal Disease. In: Stanley, T., Misra, M. (eds) Endocrine Conditions in Pediatrics. Springer, Cham. https://doi.org/10.1007/978-3-030-52215-5_3
Download citation
DOI: https://doi.org/10.1007/978-3-030-52215-5_3
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-52214-8
Online ISBN: 978-3-030-52215-5
eBook Packages: MedicineMedicine (R0)