Improving Bone Health in Pediatric Patients with Chronic Diseases

A recent article emphasized the impact of chronic illnesses and diseases during childhood and adolescence on linear growth, pubertal development, and bone mass accrual. Various conditions, such as genetic disorders, cerebral palsy, malabsorption, malignancy, autoimmune diseases, and chronic inflammatory conditions, contribute to growth and pubertal challenges. Medical treatments specific to these conditions can also adversely affect growth and puberty.

Non-communicable diseases now account for over 60% of childhood and adolescent illnesses in the developing world, with significant increases in inflammatory bowel disease (IBD) reported globally. Longevity has increased, leading to more individuals with chronic conditions surviving into adulthood. Monitoring and optimizing growth and puberty are crucial for physical and psychosocial benefits and mitigating the impact of adult health challenges.

The article discussed factors that negatively affect growth, such as – nutritional deficiencies, pro-inflammatory cytokines, hormonal variations, and reduced gene expression. Impaired pubertal bone mass acquisition increases the risk of adult osteoporosis. Glucocorticoids – the mainstay of treatment for many conditions, contribute to growth failure, delayed puberty, and reduced bone health.

A multidisciplinary assessment is essential for optimizing bone health in children with chronic diseases. New therapeutic agents have altered disease patterns, but their accessibility remains a challenge. Understanding normal bone mass accrual and pubertal development is crucial for effective interventions.

Bone density assessment and peripheral quantitative computer tomography are tools for assessing bone health. Pubertal trajectories must be observed or mimicked through treatment for optimal height and bone mass. Interventions involve achieving optimal control of the underlying disorder, nutritional support, and considering hormone replacement therapy for pubertal induction.

Efficient linear growth and bone mass accrual require addressing the underlying disorder and providing adequate nutrition. Pubertal induction is crucial, and the choice of hormone replacement depends on the condition. Regular assessments ensure pubertal progress and various interventions are outlined for specific chronic conditions, including targeted bone therapies.

There exists a need for attention to normal physiological processes, risk reduction, prevention of deterioration, and knowledge transmission to families. Regular surveillance, evidence-based recommendations, and timely endocrine assessments are essential for long-term follow-up and transition to maintain gains and prevent deterioration.

Source: Zacharin M. Indian Pediatrics. 2023 Nov;60(11):889-92.