Osteoporosis juvenil idiopática. Presentación de un caso / Idiopathic juvenile osteoporosis. A case presentation

Introdución: la osteoporosis juvenil idiopática (OJI) es el término descriptivo aplicado a la osteoporosis de etiología desconocida en la edad pediátrica. Se caracteriza por la pérdida progresiva de la masa ósea y el deterioro de su microarquitectura, lo que lleva al aumento de la fragilidad ósea y a la mayor susceptibilidad de fracturas. El principal objetivo del tratamiento de los niños y adolescentes con densidad mineral ósea disminuida es la prevención de las fracturas óseas por fragilidad. Como medidas generales, se recomienda una alimentación equilibrada, con aporte óptimo de calcio y vitamina D y la promoción de la mayor actividad física posible. Objetivo: presentar un caso de OJI y enfatizar en aspectos del diagnóstico y tratamiento. Caso clínico: adolescente, femenina, de 17 años de edad, que acudió al Departamento de Endocrinología Pediátrica del Instituto Nacional de Endocrinología a la edad de 9 años por fracturas múltiples desde los 5 años, lo que se asociaba a dolores óseos. Ante la sintomatología se indicaron los complementarios correspondientes confirmándose el diagnóstico de OJI e indicándose tratamiento con calcio y vitamina D; se evidenció una evolución favorable con mejoría clínica y radiológica, sin necesidad de administrar tratamiento con bifosfonatos

Introdution: Juvenile idiopathic osteoporosis (JIO) is the descriptive term applied to osteoporosis of unknown etiology in the pediatric age. It is characterized by the progressive loss of bone mass and the deterioration of its microarchitecture, which leads to increased bone fragility and greater susceptibility to fractures. The main objective of the treatment of children and adolescents with decreased bone mineral density is the prevention of bone fractures due to fragility. As general measures, a balanced diet with an optimal supply of calcium and vitamin D and the promotion of as much physical activity as possible is recommended. Objective: Present a case of JIO and emphasize aspects of diagnosis and treatment. Case report: Adolescent, female, 17 years old, who was attended at the Department of Pediatric Endocrinology of the National Institute of Endocrinology at the age of 9 years for multiple fractures since age 5, which was associated with bone pain. Given the symptoms and results of complementary exams, a diagnosis of JIO was confirmed, indicating treatment with calcium and vitamin D. The patient respond favorably, with clinical and radiological improvement, with no need to administer bisphosphonates

Caso atípico de osteoporosis idiopática juvenil / Atypical case of juvenile idiopathic osteoporosis

La osteoporosis idiopática juvenil es una enfermedad que aparece en niños y adolescentes, autolimitada, caracterizada por osteoporosis axial y de extremidades, en ocasiones asociada a colapso vertebral, lo que resulta finalmente en cifosis torácica. No se tiene conocimiento, hasta la fecha, de su asociación a alteraciones de la dentición. Se presenta el caso de un adolescente masculino, con historia de retraso en el cambio a la dentición permanente y osteopenia, valorado por varias especialidades médicas como: Medicina Interna, Estomatología, Ortopedia, Endocrinología y Nefrología. Se plantea el diagnóstico de osteoporosis idiopática juvenil, y se descartan, a partir del cuadro sintomatológico y los numerosos complementarios realizados, varias enfermedades hereditarias y adquiridas, entre ellas, la osteogénesis imperfecta tardía y el hiperparatiroidismo. Se destacan en este caso la presencia de alteraciones en la dentición y la poca afectación vertebral

Juvenile idiopathic osteoporosis is a disease seen in children and adolescents, it is self-limited, characterized by axial and limb osteoporosis, occasionally related to vertebral collapse, which finally resulted in thoracic kyphosis. To date, the association between this disease and dental impairments is not known. Here is the case of a male adolescent, with history of delayed change to permanent dentition and osteopenia; he was evaluated by several medical specialists as internal medicine, odontology, orthopedics, endocrinology and nephrology. He was diagnosed as juvenile idiopathic osteoporosis case, and on the basis of the symptom picture and the numerous supplementary tests, it was possible to rule out several hereditary and acquired illnesses such as late imperfect osteogenesis and hyperparathyroidism. This case stressed the presence of dentition impairments and little vertebral effect

Evidencia radiográfica de la acción de los bifosfonatos en el esqueleto inmaduro / Radiographic evidence of the action of biphosphonate on immature skeleton

Presentamos un paciente con diagnóstico de Osteoporosis Juvenil Idiopática a quien se administró ácido zolendrónico, y una serie de pacientes con diagnóstico de Osteogénesis Imperfecta tratados con pamidronato durante varios años. Se describen las imágenes osteocondensantes que aparecen en los huesos tubulares y la pelvis de estos pacientes a consecuencia de su tratamiento con bisfosfonatos, similares a las líneas de Harris (Growth Arrest Lines) que aparecen eventualmente por diversas causas en el esqueleto inmaduro.

We present one patient with Juvenile Idiopathic Osteoporosis (JIO) who was treated with Zolendronic Acid, and a small series Osteogenesis Imperfecta (OI) patients administered on eyelie Pamidronate proteol. We describe dense lines in radiographs of tubular bones and pelvis of these patients appearing. After bisphosphonates treatment, those images are similar to Harris Lines (Growth Arrest Lines) that appear occasionally by several causes on immature skeletons land through life.

Pregnancy-Acosiated Osteoporosis

A case of pregnancy associated osteoporosis in a 26 year old woman with backache and vertebral com-pression fracture is presented. The radioactive 45-Ca uptake test showed a disturbance in intestinal calcium absorption. The bone densitometry measured by dual photon absorptiometry revealed severe osteoporosis the entire lumbar spine. After months without therapy, bone mineral density of the lumbar spine and femur were increased markedly and spontaneously.

Pregnancy-Acosiated Osteoporosis

A case of pregnancy associated osteoporosis in a 26 year old woman with backache and vertebral com-pression fracture is presented. The radioactive 45-Ca uptake test showed a disturbance in intestinal calcium absorption. The bone densitometry measured by dual photon absorptiometry revealed severe osteoporosis the entire lumbar spine. After months without therapy, bone mineral density of the lumbar spine and femur were increased markedly and spontaneously.