If this peak is not optimal, it will facilitate the development of osteoporosis in adulthood. Bone matrix mineralization takes place during these stages of life, and therefore subjects reach peak bone mass at the end of this growth phase. Although it has typically been considered an adult disorder, it is becoming increasingly clear that osteoporosis might be rooted in childhood and adolescence. At present, osteoporosis is a public health problem in industrialized countries affecting about 30% of women and 8% of men older than 50 in Europe. Osteoporosis is a disorder characterized by bone mass reduction and alterations in the micro-architecture of the bone tissue resulting in bone fragility and, consequently, an elevated risk of fractures. Prophylactic measures, early diagnosis and a proper therapeutic approach are essential to improving bone health, not only in children and adolescents, but also in the adults they will become in the future. We believe it can serve as a useful tool that will contribute to the standardization of clinical practice for this pathology. In summary, we present herein guidelines for the prevention, diagnosis and treatment of secondary childhood osteoporosis based on the available evidence and expert clinical experience. All recommendations submitted to the Delphi round obtained a level of agreement of 70% or higher and were therefore accepted. This was submitted electronically and received a response rate of 40%.
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Twenty-four of them presented an evidence level 4 or 5, and therefore a Delphi survey was conducted. Resultsįifty-one recommendations, categorized into eight sections, were obtained. All recommendations that had a level of agreement higher or equal to 70% were included. This survey was sent to all members of the SERPE. A Delphi survey was conducted for those recommendations with an evidence level of IV or V. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system.
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MethodsĪn expert panel comprised of 6 pediatricians and 5 rheumatologists carried out a qualitative literature review and provided recommendations based on evidence, when that was available, or on their own experience.
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Recent changes made to the definition of childhood osteoporosis, along with the lack of guidelines or national consensuses regarding its diagnosis and treatment, have resulted in a wide variability in the approaches used to treat this disease.įor these reasons, the Osteogenesis Imperfecta and Childhood Osteoporosis Working Group of the Spanish Society of Pediatric Rheumatology has sounded the need for developing guidelines to standardize clinical practice with regard to this pathology. Osteoporosis incidence in children is increasing due to the increased survival rate of patients suffering from chronic diseases and the increased use of drugs that can damage bones.