Department of Pediatric Dentistry
Lutheran Medical Center
Resident’s Name: Albert Yamoah, DDS Date: 12/13/2017
Osteoporosis: An Increasing Concern in Pediatric Dentistry
Author(s): Marcio A. da Fonseca
Journal: Pediatric Dentistry
Major Topic: Osteoporosis, Bone Disease, Bone Mineral Density, Treatment and Management of Osteoporosis in Children
Type of Article: Literature Review
With increasing numbers of children affected by low bone density and osteoporosis, the topic has become an important issue in contemporary pediatrics.
o Bone fractures are the most common reason for hospitalization between 10 and 14 year olds.
o Factors, such as lifestyle; diet; chronic illness and medications can affect bone mineral density.
o Osteoporosis is classically defined in adults as a systemic skeletal disease characterized by:
1. Low bone mass
2. Alteration of ultra-structural quality of bone
3. Deterioration in trabecular architecture
4. Increased cortical porosity
5. Reduced cortical thickness
6. Decreased bone width
o Osteoporosis is often difficult to define in children as they are constantly changing in size and shape with increases in bone mass and density.
o Greatest bone mass acquisition tends to mirror height velocity and is greatest during puberty.
o Any disruption of this growth would lead to an increased risk of adult osteoporosis and fractures.
o Excess of deficiencies in GH, TH, PTH, and sex steroids can also lead to decreased bone mineral density.
Primary Bone disorders:
Heritable Disorders of connective tissue:
o Idiopathic juvenile osteoporosis
o Osteogenesis imperfecta
o Marfan syndrome
o Ehler-Danlos syndrome
o Bruck syndrome
o Osteoprosis pseudoglioma syndrome
Secondary Bone disorders:
o Inflammatory bowel disease
o Celiac disease
o Juvenile idiopathic arthritis
o Cystic Fibrosis
o Systemic lupus erythematosus
o Cerebral palsy
o Neuromuscular disorders
o Epidermolysis bullosa
o Spina bifida
o Spinal cord injury
o Head Injury
o Turner syndrome
o Anorexia nervosa
o Growth hormone deficiency
o Juvenile Diabetes Mellitus
o Hyperthyroidism, Hyperparathyroidism
o Cushing syndrome
o Delayed puberty
o Childhood cancer
o Sickle cell disease
Inborn Errors of Metabolism:
o Protein intolerance
o Glycogen storage diseases
o Gaucher disease
o Bone and/or cranial radiation
o Chronic renal disease
o Solid organ and hematopoietic stem cell therapy
o Anorexia nervosa
o Steroid-dependent asthma
Measuring Bone Mineral Density:
o DEXA (dual energy X-ray absorptiometry): Diagnostic tool in the management of adult osteoporosis.
o DEXA doesn’t distinguish between cortical and trabecular bone
o DEXA does not differentiate between body types for a certain age (i.e. short kids vs. tall).
o DEXA is beneficial to use as a monitor during tx.
Treating Osteoporosis in Children:
o Anticipatory guidance regarding healthy lifestyle (physical activity, diet, no drugs/alcohol) is of great importance to prevent bone loss and should start from an early age.
o In severe cases of low bone mineral density, promoting calcium and Vitamin D intake coupled with weight-bearing physical activity can provide benefits with minimal risk.
Implications of Osteoporosis in Dental Treatment:
o Getting a full medical history is important.
o Dentist should be careful when using restraints with child diagnosed with osteoporosis as bone fractures may result.
o Extractions should be done carefully as to avoid any unnecessary jaw fractures.
o Dentists should be aware of the patient’s current therapy.
o Bisphosphonate therapy may lead to BRONJ.
o Elimination of all potential sources of odontogenic and mucosal infection must be done before the patient starts therapy with bisphosphonates.
o There are no reported cases of BRONJ developing from primary tooth extraction. However, it is always important to consult with the child’s physician prior to any surgical therapy.
o Bisphosphonates can also inhibit tooth movement: posing a problem for orthodontic therapy (reduced osteoclasts)
o It is suggested that orthodontic treatment be avoided in patients with high risk, such as those patients receiving or have received IV Bisphosphonate.
o Bisphosphonate has also been associated with delayed tooth eruption with OI and with ulcers when pills come in contact with oral mucosa.
Assessment of Article: Very informative
Level of Evidence/Comments: Level III