Practical approach to the diagnosis, management, and treatment of pediatric patients with bone fragility: an expert opinion. in Journal of endocrinological investigation / J Endocrinol Invest. 2026 Sep;49(9):2113-2134. doi: 10.1007/s40618-026-02882-8. Epub 2026 Jun 24.

2026
AOU Alessandria

Tipo pubblicazione

Review

Autori/Collaboratori (22)Vedi tutti...

Baroncelli GI
Pediatric and Adolescent Endocrinology, Division of Pediatrics, Department of Obstetrics, Gynecology and Pediatrics, University Hospital, Pisa, Italy.
Tessaris D
Pediatric Endocrinology, Department of Public Health and Pediatrics, University of Turin, Regina Margherita Children's Hospital, Turin, Italy.
Aversa T
Department of Human Pathology of Adulthood and Childhood, University of Messina, Messina, Italy.

et alii...

Abstract

PURPOSE: Children and adolescents frequently experience fractures related to accidental injuries; however, fractures may also result from non-accidental trauma in abused children or from underlying bone fragility due to primary or secondary osteoporosis. In pediatric patients with fragility fractures diagnosis and treatment may be delayed. This document aims to provide clinicians with a practical approach to the diagnosis and management of fragility fractures in children and adolescents. METHODS: Between November 2024 and June 2025, a group of Italian pediatric endocrinologists with expertise in bone and mineral metabolism held regular online meetings to discuss key issues related to the diagnosis and management of pediatric bone fragility and developed experts opinion statements based on clinical experience and a review of the relevant literature. RESULTS: The expert panel formulated consensus statements on the clinical management of children and adolescents with fragility fractures. Seven main areas were addressed: 1) definition of fragility fractures and pediatric osteoporosis; 2) diagnostic approach; 3) main causes of primary and secondary osteoporosis; 4) assessment of the potential for spontaneous recovery from bone fragility; 5) management of bisphosphonate therapy; 6) other therapeutic options; 7) conservative measures. CONCLUSION: The diagnosis of osteoporosis in pediatric patients should follow a clinically oriented approach. Genetic testing plays a crucial role in identifying primary forms of osteoporosis. Vertebral reshaping may occur in some patients with secondary osteoporosis. Bisphosphonates represent the mainstay of treatment in children and adolescents with bone fragility. Conservative measures aimed at optimizing bone strength may be beneficial in selected cases.

Accesso banca dati bibliografica

PMID : 42340621

DOI : 10.1007/s40618-026-02882-8

Keywords

Humans; Child; Osteoporosis/diagnosis/therapy; Adolescent; Osteoporotic Fractures/diagnosis/therapy/etiology; Bone Density Conservation Agents/therapeutic use; Diphosphonates/therapeutic use; Bone Density; Disease Management; Adolescents; Bisphosphonates; Children; Fragility fractures; Osteoporosis; Vertebral reshaping;