Abstract：
Bone development is a highly orchestrated process that establishes the structural basis of bone strength during growth and functionality across the lifespan. This developmental process is generally robust in establishing mechanical function, being adaptable to many genetic and environmental factors. However, not all factors can be fully accommodated, leading to abnormal bone development and lower bone strength. This can give rise to early-onset bone fragility that negatively impacts bone strength across the lifespan. Current guidelines for assessing bone strength include measuring bone mineral density, but this does not capture the structural details responsible for whole bone strength in abnormally developing bones that would be needed to inform clinicians on how and when to treat to improve bone strength. The clinical consequence of not operationalizing how altered bone development informs decision making includes under-detection and missed opportunities for early intervention, as well as a false positive diagnosis of fragility with possible resultant clinical actions that may actually harm the growing skeleton. In this Perspective, we emphasize the need for a multi-trait, integrative approach to better understand the structural basis of bone growth for pediatric conditions with abnormal bone development. We provide evidence to showcase how this approach might reveal multiple, unique ways in which bone fragility develops across and within an array of pediatric conditions that are associated with abnormal bone development. This Perspective advocates for the development of new translational research aimed at informing better ways to optimize bone growth, prevent fragility fractures, and monitor and treat bone fragility based on the child\'s skeletal needs.
摘要：
骨发育是一个高度协调的过程，在整个生命周期的生长和功能过程中建立了骨强度的结构基础。这种发展过程在建立机械功能方面通常是稳健的，适应许多遗传和环境因素。然而,并非所有因素都能完全适应，导致骨发育异常和骨强度降低。这可能会导致早发性骨脆性，从而在整个生命周期中对骨强度产生负面影响。目前评估骨强度的指南包括测量骨矿物质密度，但这并没有捕获异常发育骨骼中负责整个骨骼强度的结构细节，这些细节需要告知临床医生如何以及何时治疗以提高骨骼强度。未实施骨发育改变如何告知决策的临床后果包括检测不足和错过早期干预的机会。以及脆性的假阳性诊断，并可能导致可能实际上损害不断增长的骨骼的临床行为。从这个角度来看,我们强调需要多特征，综合方法，以更好地了解骨发育异常的儿科疾病的骨生长的结构基础。我们提供证据来展示这种方法如何揭示多种，骨脆性在一系列与骨发育异常相关的儿科疾病中发展的独特方式。这个观点提倡开发新的转化研究，旨在提供更好的方法来优化骨骼生长，防止脆性骨折，并根据孩子的骨骼需求监测和治疗骨骼脆性。
