Causes of secondary pediatric osteoporosis.

Secondary osteoporosis is increasingly observed in both adult and pediatric patients affected by many heterogeneous diseases. Most forms of secondary osteoporosis derive from one or more of the following causes: malnutrition, malabsorption, immobilization and/or reduced mechanical load, vitamin D deficiency, chronic inflammation, hormonal derangements, and chronic use of glucocorticoids and other drugs. Considering the lack of symptoms in the early phases, both the risk and the presence of secondary osteoporosis tend to be underestimated, and as a consequence, appropriate prevention/treatment measures are often delayed or not taken at all. Failure to accumulate an appropriate bone mass for gender and age or to build an architecturally "strong" bone must always be suspected when a child or adolescent presents with frequent and/or low-trauma fractures, chronic bone pain, or an incidental finding of "osteopenia" on plain X-rays. Known risk factors must always be considered.