ESPE Yearbook of Paediatric Endocrinology

In brief: This up-to-date and very clear review describes the diagnosis and management of primary or secondary bone fragility in children and adolescents.

Commentary: The field of bone fragility in children has evolved considerably in recent years, particularly in terms of diagnosis and management. This progress has been made possible in particular by the discovery of new genes involved in childhood-onset bone fragility, and also by a better understanding of the natural history of bone fragility secondary to acute or chronic pathology.

This review provides a step-by-step guide to the diagnosis and management of children presenting with fragility fractures. It also addresses unmet needs, particularly the need for an expanded toolbox of effective osteoporosis agents in children, including anabolic agents. In the case of secondary bone fragility, an important point highlighted in this review is the potential for resolution of bone fragility in growing children once the risk factors have been removed (e.g. recovery from acute leukaemia). After the diagnostic phase, assessing this potential for spontaneous healing is a key step in determining the need for drug treatment to increase bone mass. In terms of therapeutic options, there is currently virtually only one treatment available: bisphosphonates, which have the potential to inhibit bone resorption. Although the efficacy and tolerability of bisphosphonates in primary and secondary bone fragility have been widely reported, one of the challenges for the future is to develop new treatments, particularly those with an anabolic effect on bone.