Evaluation and Treatment of Bone Disease in Youth with Chronic Health Conditions

Patients at the transition from adolescence to adulthood challenge healthcare providers when they are confronted with problems of bone fragility. Although the skeleton has completed its growth, miner-alization continues resulting in increased demands for protein, calcium and phosphorus. Many of these individuals, because of certain diseases addressed in this manuscript, face other insults to the bone from the lack of reproductive hormones that aid in bone maturation, inadequate nutrition, or medications that interfere with normal bone metabolism. Some organizations recommend bone density testing as a way to determine risk of fracture. There has been little research to address pharmacologic treatment for youth and young adults at risk for having fragile bones. Adding to these challenges is the lack of evidence-based therapies that have been shown to reduce fractures. Therefore, pharmaceutical inter-vention, beyond Vitamin D and Calcium, should be reserved for those with demonstrated fractures secondary to bone fragility. This article will highlight these particular issues in the transition patient and recommend evaluation and treatment based on current scientific literature.