Prevention of osteoporosis and bone fragility: a pediatric concern

The importance of optimal bone growth in childhood and adolescence has been recognized as one of the key strategies in osteoporotic fracture prevention. Low birth size, poor childhood growth, and low peak bone mass at the cessation of growth have been linked to the later risk of osteoporosis and hip fracture. Formerly, the focus was merely on maximizing bone mineral accrual because a high peak bone mineral mass may prevent attainment of a critical "fracture threshold" associated with age-related bone loss and osteoporosis. More recently, the focus has shifted away from bone mineral accrual-as measured by dual-energy X-ray absorptiometry (DXA)-toward the optimization of bone strength. This is partly because of the advances in bone imaging that have enabled estimation of bone strength beyond bone mass. In this review, we briefly describe long-bone growth and structural development and our abilities to assess bone properties by medical imaging tools. In addition, we summarize the evidence of factors contributing to skeletal growth, bone fragility, and the development of strong, healthy bones