Practical approach to the diagnosis, management, and treatment of pediatric patients with bone fragility: an expert opinion
PURPOSE: Children and adolescents frequently experience fractures related to accidental injuries; however, fractures may also result from non-accidental trauma in abused children or from underlying bone fragility due to primary or secondary osteoporosis. In pediatric patients with fragility fractures diagnosis and treatment may be delayed. This document aims to provide clinicians with a practical approach to the diagnosis and management of fragility fractures in children and adolescents. METHODS: Between November 2024 and June 2025, a group of Italian pediatric endocrinologists with expertise in bone and mineral metabolism held regular online meetings to discuss key issues related to the diagnosis and management of pediatric bone fragility and developed experts opinion statements based on clinical experience and a review of the relevant literature. RESULTS: The expert panel formulated consensus statements on the clinical management of children and adolescents with fragility fractures. Seven main areas were addressed: 1) definition of fragility fractures and pediatric osteoporosis; 2) diagnostic approach; 3) main causes of primary and secondary osteoporosis; 4) assessment of the potential for spontaneous recovery from bone fragility; 5) management of bisphosphonate therapy; 6) other therapeutic options; 7) conservative measures. CONCLUSION: The diagnosis of osteoporosis in pediatric patients should follow a clinically oriented approach. Genetic testing plays a crucial role in identifying primary forms of osteoporosis. Vertebral reshaping may occur in some patients with secondary osteoporosis. Bisphosphonates represent the mainstay of treatment in children and adolescents with bone fragility. Conservative measures aimed at optimizing bone strength may be beneficial in selected cases.
Authors
- Marco Pitea
- Małgorzata Waśniewska (ORCID: https://orcid.org/0000-0002-8299-2677)
- Domenico Corica (ORCID: https://orcid.org/0000-0002-3628-1612)
- Luisa De Sanctis (ORCID: https://orcid.org/0000-0003-2113-6196)
- Giampiero I. Baroncelli (ORCID: https://orcid.org/0000-0001-8465-5087)
- Natascia Di Iorgi (ORCID: https://orcid.org/0000-0002-4492-4585)
- Francesco Vierucci (ORCID: https://orcid.org/0000-0002-2192-518X)
- Stefano Mora (ORCID: https://orcid.org/0000-0002-4781-6715)
- Maria Felicia Faienza (ORCID: https://orcid.org/0000-0002-1899-8337)
- Pasquale Comberiati (ORCID: https://orcid.org/0000-0001-5209-9733)
- Silvia Longhi
- Danilo Fintini (ORCID: https://orcid.org/0000-0002-0103-7951)
- Roberto Franceschi (ORCID: https://orcid.org/0000-0002-2230-7148)
- Anna Grandone (ORCID: https://orcid.org/0000-0002-6343-4768)
- Flavia Urbano (ORCID: https://orcid.org/0000-0002-9985-7084)
- Andrea Secco
- Daniele Tessaris (ORCID: https://orcid.org/0000-0002-6484-4371)
- Tommaso Aversa (ORCID: https://orcid.org/0000-0002-1754-6822)
- Enrica Bertelli (ORCID: https://orcid.org/0000-0002-9597-833X)
- Giuliana Trifirò
- Graziamaria Ubertini
- Mila Ann Karapurackal (ORCID: https://orcid.org/0009-0004-2186-9853)
Institutions
- University of Pisa (IT)
- University of Messina (IT)
- IMT School for Advanced Studies Lucca (IT)
- University of Trento (IT)
- Istituto Giannina Gaslini (IT)
- Martin University (US)
- Ospedale di Bolzano (IT)
- IRCCS Policlinico San Donato (IT)
- Bambino Gesù Children's Hospital (IT)
- University of Campania "Luigi Vanvitelli" (IT)
- IRCCS Ospedale San Raffaele (IT)
- Ospedale Regina Margherita (IT)
- Ospedale Pediatrico Giovanni XXIII (IT)
- Istituti di Ricovero e Cura a Carattere Scientifico (IT)
- Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo (IT)
- Azienda Ospedaliera Universitaria Pisana (IT)
- University of Bari Aldo Moro (IT)
- University of Genoa (IT)
Publication Details
- Journal
- Journal of Endocrinological Investigation
- Published
- 2026-06-24
- DOI
- https://doi.org/10.1007/s40618-026-02882-8
- Primary Topic
- Bone fractures and treatments
- Type
- article
- Field-Weighted Citation Impact
- 0.00