Miguel Angel Guagnelli
Asociacion Medica Centro Medico, Mexico
Title: Adult osteoporosis as a pediatric disease An approach to bone health for pediatric endocrinologists
Biography
Biography: Miguel Angel Guagnelli
Abstract
We acquire most of the bone mineral density before we reach the 30 years of age and then it starts declining at different rates for different people but almost inevitably. Most of the bone accrual actually takes place during the pediatric age and many factors may alter it, with consequences not evident until many years later. Therefore during recent years the focus of osteoporosis study has widened not only to prevent bone loss but to promote bone health during infancy, puberty and young adult ages. As the knowledge on pediatric bone density has widened, the definition of osteoporosis in such population has changed from the WHO description for adults and its measure is made as a Z-score instead of a T-score, with different considerations taken into account. Several tools have been used for this matter, including the widely used Dual-Energy X-ray Absortiometry (DXA) as well as central and peripheral tomography and ultrasound, to name a the better known. Using them, a number of countries have developed curves of normality in their pediatric population in order to have reference data to compare such cases in which a lower density is suspected due to disease, nutrition or some other risk factors. Among these, low consumption or absorption of calcium and vitamin D are the most frequent and relatively easy to prevent in one end, congenital severe diseases altering the bone on the other and chronic diseases and treatment of oncologic diseases in the middle of the range of possible skeletal alterations. New tools have been developed to have a better look not only of the mineral contents of the bone, but also to have a better insight of the trabecular and cortical structure of the bone while trying to minimize the radiation exposure of this, a particularly susceptible group. Peripheral quantitative computerized tomography (pQCT) for long bones and Trabecular Bone Score (TBS) for vertebrae using conventional DXA have found great acceptance and are gathering data which may lead during the following years to improve general bone health during childhood and prevent osteoporosis from an earlier age.