Bone Mineral Density as a Predictor of Vertebral Fractures in Children and Adolescents

There has been significant progress in our understanding of the natural history of vertebral fractures and associated risk and protective factors in children with osteoporotic conditions in recent years. This knowledge has allowed us to develop logical approaches to the diagnosis, monitoring, and timing of intervention in this setting. Current treatment strategies are predicated upon monitoring at-risk children to identify and then treat early signs of vertebral collapse in those with less potential for spontaneous vertebral body reshaping (i.e. a secondary prevention approach). On the other hand, trials addressing primary prevention are needed for children with both a high likelihood of developing vertebral fractures and with persistent risk factors for vertebral fractures (thereby obviating the potential for spontaneous vertebral body reshaping). Bone mineral density provides important, adjuvant information about the child’s overall bone health trajectory, signaling a child who is at increased risk for vertebral fractures or who is showing signs of spontaneous recovery from a transient bone health threat.Overall, this chapter focuses on the following aspects of the pediatric bone health assessment: (a) vertebral fractures as a manifestation of osteoporosis in children (diagnostic methods, prevalence, and incidence in various disease states), (b) clinical predictors of vertebral fractures, including BMD, (c) BMD restitution and vertebral body reshaping of previously fractured vertebral bodies as indices of recovery, and (d) the impact of the relationship between BMD and vertebral fractures on clinical practice. Taken together, these discussion points will assist clinicians in the diagnosis and monitoring of bone health in at-risk children, and in making decisions around optimal candidates for bone-targeted treatment.