Abstract：
Glucocorticoid (GC) therapy remains the cornerstone of treatment for many conditions of childhood and an important cause of skeletal and endocrine morbidity. Here, we discuss cases that bring to life the most important concepts in the management of pediatric GC-induced osteoporosis (pGIO). Given the wide variety of underlying conditions linked to pGIO, we focus on the fundamental clinical-biological principles that provide a blueprint for management in any clinical context. In so doing, we underscore the importance of longitudinal vertebral fracture phenotyping, how knowledge about the timing and risk of fractures influences monitoring, the role of bone mineral density in pGIO assessments, and the impact of growth-mediated \"vertebral body reshaping\" after spine fractures on the therapeutic approach. Overall, pGIO management is predicated upon early identification of fractures (including vertebral) in those at risk, and timely intervention when there is limited potential for spontaneous recovery. Even a single, low-trauma long bone or vertebral fracture can signal an osteoporotic event in an at-risk child. The most widely used treatments for pediatric osteoporosis, intravenous bisphosphonates, are currently recommended first-line for the treatment of pGIO. It is recognized, however, that even early identification of bone fragility, combined with timely introduction of the most potent bisphosphonate therapies, may not completely prevent osteoporosis progression in all contexts. Therefore, prevention of first-ever fractures in the highest-risk settings is on the horizon, where there is also a need to move beyond anti-resorptives to the study of anabolic agents.
摘要：
糖皮质激素（GC）治疗仍然是许多儿童疾病治疗的基石，也是骨骼和内分泌发病的重要原因。这里,我们讨论了使儿童GC诱导的骨质疏松症（pGIO）管理中最重要的概念栩栩如生的案例。鉴于与pGIO相关的各种潜在条件，我们专注于为任何临床背景下的管理提供蓝图的基本临床生物学原则。这样做,我们强调纵向椎体骨折表型的重要性，关于骨折时间和风险的知识如何影响监测，骨矿物质密度在pGIO评估中的作用，以及脊柱骨折后生长介导的“椎体重塑”对治疗方法的影响。总的来说,pGIO管理基于早期识别有风险的骨折（包括椎骨），并在自发恢复的可能性有限时及时进行干预。即使是单身,低创伤长骨或椎骨骨折可预示高危儿童发生骨质疏松事件.最广泛使用的治疗小儿骨质疏松症，静脉注射双膦酸盐，目前建议一线治疗pGIO。它是公认的，然而,即使是早期识别骨骼脆性，结合及时引入最有效的双膦酸盐疗法，可能无法在所有情况下完全预防骨质疏松症的进展。因此,在最高风险环境中预防首次骨折即将到来，在那里还需要超越抗吸收剂，研究合成代谢药物。
