{"id":7981,"date":"2025-11-17T17:42:27","date_gmt":"2025-11-17T17:42:27","guid":{"rendered":"https:\/\/neuropediatoolkit.org\/?p=7981"},"modified":"2026-10-27T22:30:08","modified_gmt":"2026-10-27T22:30:08","slug":"protocolo-de-osteoporosis","status":"publish","type":"post","link":"https:\/\/neuropediatoolkit.org\/en\/protocolo-de-osteoporosis\/","title":{"rendered":"Osteoporosis protocol (Galindo-Zavala):"},"content":{"rendered":"<h2 class=\"wp-block-heading\">Osteoporosis infantil: diagn\u00f3stico y criterios<\/h2>\n\n\n<p class=\"wp-block-paragraph\">Definici\u00f3n cl\u00ednica: fracturas por fragilidad (sin trauma de alta energ\u00eda ni enfermedad local).<\/p>\n\n\n<h3 class=\"wp-block-heading\">Criterios diagn\u00f3sticos (ISCD 2019)<\/h3>\n\n\n<ul class=\"wp-block-list\">\n<li>Fractura vertebral por fragilidad (sin causa local o trauma elevado).<\/li>\n<li>Z-score de DMO\/CMO \u2264 -2 (ajustado a talla si <3er percentil), asociado a:\n<ul>\n<li>\u22652 fracturas de huesos largos antes de 10 a\u00f1os.<\/li>\n<li>\u22653 fracturas de huesos largos antes de 19 a\u00f1os.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n<h3 class=\"wp-block-heading\">S\u00edndromes cerebro-renales de causa gen\u00e9tica\/estructural<\/h3>\n\n\n<p class=\"wp-block-paragraph\">Presentan fragilidad \u00f3sea como componente central. Incluyen:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>S\u00edndrome de Osteoporosis Infantil con Deficiencia de Osteoprotegerina (OPG) o RANKL.<\/li>\n<li>S\u00edndromes con hipofosfatemias hereditarias (ej. S\u00edndrome de Dent, S\u00edndrome de Leprechaun).<\/li>\n<li>Defectos en el sistema RANK\/RANKL\/OPG, que alteran la remodelaci\u00f3n \u00f3sea.<\/li>\n<li>Diagn\u00f3stico: evaluaci\u00f3n cl\u00ednica, radiograf\u00eda (fracturas vertebrales), DMO, y estudios gen\u00e9ticos si indicado.<\/li>\n<\/ul>\n\n\n<h3 class=\"wp-block-heading\">Im\u00e1genes y evaluaci\u00f3n<\/h3>\n\n\n<p class=\"wp-block-paragraph\">Localizaci\u00f3n DXA recomendada:<\/p>\n\n\n\n<figure class=\"wp-block-table\">\n<table class=\"has-fixed-layout\">\n<thead>\n<tr>\n<th>Age<\/th>\n<th>DXA recomendada<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td>&lt; 5 a\u00f1os<\/td>\n<td>lumbar spine<\/td>\n<\/tr>\n<tr>\n<td>\u2265 3 years<\/td>\n<td>Cuerpo entero (sin cabeza)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<figcaption class=\"wp-element-caption\">Figura 1. Radiograf\u00eda de columna dorsal en proyecci\u00f3n anteroposterior que muestra p\u00e9rdida de altura de v\u00e9rtebras dorsales con deformidad en caj\u00f3n, caracter\u00edstica de fracturas vertebrales por fragilidad en osteoporosis infantil.<\/figcaption>\n<\/figure>\n\n<h3 class=\"wp-block-heading\">Tratamiento: bisfosfonatos<\/h3>\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Indicaci\u00f3n:<\/strong> siempre que se cumplan criterios de osteoporosis (prevenci\u00f3n de nuevas fracturas).<\/li>\n<li><strong>Uso en baja DMO:<\/strong> en Tanner 2, si Z-score &lt; -2,5 con tendencia descendente, o &lt; -3 sin factores de riesgo.<\/li>\n<li><strong>Complicaciones:<\/strong>\n<ul>\n<li>S\u00edndrome pseudogripal (fiebre, mialgias): 1\u20133 d\u00edas tras infusi\u00f3n; control con paracetamol.<\/li>\n<li>Hipocalcemia (asintom\u00e1tica com\u00fan), hipofosforemia, hipomagnesemia.<\/li>\n<li>Reacciones raras: uve\u00edtis, osteonecrosis mandibular (muy raras en pediatr\u00eda).<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n<h3 class=\"wp-block-heading\">Medidas para reducir riesgos<\/h3>\n\n\n<ul class=\"wp-block-list\">\n<li>Verificar calcio i\u00f3nico a las 48 h post-infusi\u00f3n.<\/li>\n<li>Asegurar vitamina D \u2265 30 ng\/dL y calcio adecuado antes del tratamiento.<\/li>\n<li>Revisi\u00f3n odontol\u00f3gica cada 6 meses.<\/li>\n<li>Suspender 3\u20134 meses antes de osteotom\u00eda electiva.<\/li>\n<li>Ecograf\u00eda renal si hipercalciuria (para descartar nefrocalcinosis).<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Recursos \u00fatiles:<\/strong> <a href=\"https:\/\/zscore.research.chop.edu\/calcpedbonedens.php\" target=\"_blank\">Calculadora de Z-score pedi\u00e1trico (CHOP)<\/a> | <a href=\"https:\/\/www.bedca.net\/bdpub\/index.php\" target=\"_blank\">Base de Datos BEDCA<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Claves:<\/strong> Diagn\u00f3stico basado en fracturas por fragilidad o Z-score \u2264 -2; considerar s\u00edndromes gen\u00e9ticos en casos no secundarios. Tratamiento con bisfosfonatos en indicaciones claras, con seguimiento estricto.<\/p>\n\n\n<figure class=\"wp-block-table\"><table class=\"has-fixed-layout\"><thead><tr><th>Age<\/th><th>Recommended DXA location<\/th><\/tr><\/thead><tbody><tr><td>Infants and preschoolers (&lt; 5 years)<\/td><td>lumbar spine<\/td><\/tr><tr><td>\u2265 3 years<\/td><td>Whole body (excluding head)<\/td><\/tr><\/tbody><\/table><figcaption class=\"wp-element-caption\">Figura 1. Radiograf\u00eda de columna dorsal en proyecci\u00f3n anteroposterior que muestra p\u00e9rdida de altura de v\u00e9rtebras dorsales con deformidad en caj\u00f3n, caracter\u00edstica de fracturas vertebrales por fragilidad en osteoporosis infantil.<\/figcaption><\/figure>","protected":false},"excerpt":{"rendered":"<p>Osteoporosis infantil: diagn\u00f3stico y criterios Definici\u00f3n cl\u00ednica: fracturas por fragilidad (sin trauma de alta energ\u00eda ni enfermedad local). Criterios diagn\u00f3sticos (ISCD 2019) Fractura vertebral por fragilidad (sin causa local o trauma elevado). Z-score de DMO\/CMO \u2264 -2 (ajustado a talla si<\/p>","protected":false},"author":1,"featured_media":8013,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_themeisle_gutenberg_block_has_review":false,"footnotes":""},"categories":[52,24],"tags":[],"class_list":["post-7981","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-enfermedades-neuropediatricas-clasicas","category-farmacos","entry"],"_links":{"self":[{"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/posts\/7981","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/comments?post=7981"}],"version-history":[{"count":7,"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/posts\/7981\/revisions"}],"predecessor-version":[{"id":8909,"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/posts\/7981\/revisions\/8909"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/media\/8013"}],"wp:attachment":[{"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/media?parent=7981"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/categories?post=7981"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/tags?post=7981"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}