{"id":7981,"date":"2025-11-17T17:42:27","date_gmt":"2025-11-17T17:42:27","guid":{"rendered":"https:\/\/neuropediatoolkit.org\/?p=7981"},"modified":"2025-12-25T18:47:38","modified_gmt":"2025-12-25T18:47:38","slug":"protocolo-de-osteoporosis","status":"publish","type":"post","link":"https:\/\/neuropediatoolkit.org\/en\/protocolo-de-osteoporosis\/","title":{"rendered":"Osteoporosis protocol:"},"content":{"rendered":"<p>CHILDREN'S OSTEOPOROSIS = presence of fragility fractures.<br>The International Society of Clinical Densitometry (ISCD), in its latest consensus of 2019,<br>considers two possible conditions for the diagnosis of childhood osteoporosis:<br>\u2013 Presence of one or more vertebral fractures in the absence of local disease or<br>high energy trauma.<br>\u2013 BMD or BMC Z-score less than -2 (adjusted to height in children size &lt; P3) associated with<br>a history of clinically significant fractures, considered as such:<br>\u2013 Two or more long bone fractures under the age of 10.<br>\u2013 Three or more long bone fractures under the age of 19<\/p>\n\n\n\n<p>** A Z-score greater than -2 does not exclude the possibility of bone fragility and predisposition to<br>suffer fractures, especially in those patients affected by pathologies that favor the appearance of<br>2nd osteoporosis: **Immobility, pubertal delay, little sun exposure, nutritional deficiency, sustained inflammatory activity and exposure to osteotoxic drugs, such as corticosteroids or antiepileptics.<\/p>\n\n\n\n<p>In infants and preschoolers:<br>Lumbar DXA  = 3 years<\/p>\n\n\n\n<p><a href=\"https:\/\/zscore.research.chop.edu\/calcpedbonedens.php\">https:\/\/zscore.research.chop.edu\/calcpedbonedens.php<\/a><\/p>\n\n\n\n<p><a href=\"https:\/\/www.bedca.net\/bdpub\/index.php\">https:\/\/www.bedca.net\/bdpub\/index.php<\/a><\/p>\n\n\n\n<p>The recommended daily dose of vitamin D in the healthy child:<br>\u2013  1 year: 600 IU<br>The American Academy of Pediatrics recommends vitamin D supplementation in:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>All newborns (first days of life until one year of age).<\/li>\n\n\n\n<li>Children 1-2 years old who must drink milk or skimmed milk products.<\/li>\n\n\n\n<li>Children who drink &lt; 1 L of milk not fortified with vitamin D.<\/li>\n\n\n\n<li>Adolescents who do not take 400 IU\/day.<\/li>\n\n\n\n<li>Children at risk of vitamin D deficiency (malabsorption, antiepileptic medication...) should<br>receive higher doses daily based on the serum level of 25 OH vitamin D. Monitor<br>every 6 months.<\/li>\n\n\n\n<li>There is NO recommended daily dose of calcium and vitamin D in children with chronic pathologies.<\/li>\n\n\n\n<li>In children affected by chronic pathologies with low BMD for chronological age: supplement with calcium and<br>vitamin D at the recommended doses in healthy children and modify its dose depending on iPTH, calciuria and<br>vitamin D levels.<\/li>\n\n\n\n<li>Diet rich in fruits and vegetables<\/li>\n\n\n\n<li>Oral or inh corticosteroid therapy. Calcium and vitamin D should be supplemented if prednisone dose &gt; = 5 mg\/day<\/li>\n<\/ul>\n\n\n\n<p>In the latest consensus on the use of bisphosphonates in children and adolescents, it is<br>They always recommend that they meet osteoporosis criteria.<br>GOAL: Prevent new fragility fractures<br>They can be considered in patients WITHOUT osteoporosis, but with low BMD at the beginning of treatment.<br>puberty (Tanner 2) in two situations:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>If the risk factors persist and the Z-score is &lt; -2.5 with a downward trend<br>in two determinations separated by at least one year.<\/li>\n\n\n\n<li>In the absence of risk factors, if the Z-score is &lt; -3 with a downward trend in<br>two determinations separated by at least one year.<\/li>\n<\/ul>\n\n\n\n<p>General well tolerated.<br>\u25a0 IV bisphosphonates:<br>\u2013 Flu-like syndrome with fever, malaise, nausea, diarrhea and generalized myalgia at the beginning of treatment. 1st and 3rd day of<br>treatment, last a few days and rarely recur in successive doses. They subside with paracetamol.<br>\u2013 Asymptomatic hypocalcemia, in some cases arrhythmias, laryngospasm and tetany.<br>\u2013 Asymptomatic hypophosphoremia and hypomagnesemia<br>\u2013 Others: uveitis, thrombopenia or oral or esophageal ulcers and osteonecrosis of the jaw<br>** TO REDUCE RISK:<br>Request ionic calcium 48 hours after the infusion<br>Ensure adequate levels of vitamin D and calcium before starting treatment.<br>Dental checkup before and every 6 months during bisphosphonate therapy.<br>Discontinue treatment 3 to 4 months before any elective osteotomy and restart only when the callus is<br>formed.<br>Kidney ultrasound: detect nephrocalcinosis in relation to vitamin D supplementation<br>Calcemia monitoring of newborns of mothers treated with bisphosphonates before or during pregnancy.<\/p>\n\n\n\n<p>INSTRUCTIONS FOR THE ADMINISTRATION OF<br>PAMIDRONATE\/ZOLEDRONATE<br>Before each infusion check vitamin D &gt;= 30 ng\/dL, normal calcium and kidney function.<br>For the first infusion, administer half the dose.<br>Administer paracetamol before the infusion to reduce side effects (fever,<br>pain).<br>Administer (or increase) calcium supplements the week before and the week before<br>after treatment.<\/p>\n\n\n\n<p>\u25a0 DXA, depending on the treatment they receive.<br>\u2013 If prolonged corticosteroid treatment: Annually or Biennially while the treatment lasts and even every 6<br>months, with the first recommended 3 months after the start of corticosteroid therapy.<br>\u2013 In patients with chronic diseases who do not receive treatment with corticosteroids, there is no consensus,<br>must be individualized according to:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>the underlying disease,<\/li>\n\n\n\n<li>bone quality at initial evaluation,<\/li>\n\n\n\n<li>the nutritional status,<\/li>\n\n\n\n<li>lifestyle habits and<\/li>\n\n\n\n<li>the appearance of fractures<br>\u25a0 Spinal X-ray: after one year if low bone mass or risk factor persists.<br>\u25a0 Analytics: annual<br>\u25a0 Renal ECHO: if hypercalciuria to rule out nephrocalcinosis.<\/li>\n<\/ul>\n\n\n\n<p>the underlying disease, the quality of the bone in the initial evaluation, the nutritional status, lifestyle habits and the appearance of fractures.\n\n\u25a0 Spinal X-ray: after one year if low bone mass or risk factor persists.\n\n\u25a0 Analytics: annual.\n\n\u25a0 Renal ECHO: if hypercalciuria, to rule out nephrocalcinosis.<\/p>\n\n\n\n<p><\/p>","protected":false},"excerpt":{"rendered":"<p>CHILDREN'S OSTEOPOROSIS = presence of fragility fractures. The International Society of Clinical Densitometry (ISCD), in its latest consensus in 2019, considers two possible conditions for the diagnosis of childhood osteoporosis: \u2013 Presence of one or more vertebral fractures in the absence of local disease or high-energy trauma. \u2013 BMD or CMO Z-score less than -2 (adjusted... <\/p>\n<p class=\"link-more\"><a href=\"https:\/\/neuropediatoolkit.org\/en\/protocolo-de-osteoporosis\/\" class=\"more-link\">Continue reading<span class=\"screen-reader-text\"> \u00abOsteoporosis protocol:\u00bb<\/span><\/a><\/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":2,"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/posts\/7981\/revisions"}],"predecessor-version":[{"id":8014,"href":"https:\/\/neuropediatoolkit.org\/en\/wp-json\/wp\/v2\/posts\/7981\/revisions\/8014"}],"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}]}}