Risk factors:
(1) severe mobilization impairment (spina bifida, severe cerebral palsy) with no independent weight bearing
(2) placement of spica cast
(3) poor nutritional intake
(4) medications associated with osteoporosis (phenytoin, corticosteroids, others)
(5) history of previous fracture
Clinical features:
(1) fractures in limbs
(2) decreased bone mineral density, which may get worse with age
Bone mineral density is worse in the proximal femur than in vertebrae. However, the presence of limb contractures may make measuring bone mineral density in the proximal femur difficult.
Because of the poor quality of bone the fracture healing may be poor.
Management:
(1) Minimize risk factors for osteoporosis and osteomalacia.
(2) Provide good nutrition.
(3) Avoid falls.
(4) Control pain (minimizing problems such as constipation)
(5) Minimize periods of immobilization.
These children may also be at risk for osteomalacia associated with limited sunlight exposure (sunlight is needed for generation of vitamin D3).
