Diagnosis and management of bone fragility fractures in children and adolescents: Good Clinical Practice Recommendations of the Italian Society of Pediatric Endocrinology and Diabetology (ISPED)
Abstract Fragility fractures in children and adolescence represent a clinically relevant and potentially under-recognized condition that may reflect an underlying impairment of bone strength due to primary or secondary causes. Despite their potential impact on growth, quality of life, and long-term skeletal health, the identification and management of pediatric bone fragility remain heterogeneous, largely due to the lack of guidelines and the limited availability of high-quality pediatric evidence. To address this gap, a multidisciplinary panel of experts from the Italian Society of Pediatric Endocrinology and Diabetology, in collaboration with other national scientific societies developed Good Clinical Practice Recommendations for the diagnosis and management of children and adolescents with fragility fractures. The development process followed the methodological framework of the Italian National Guideline System and was based on a systematic literature review and the GRADE methodology. Four key clinical questions were addressed: (1) the role of dual-energy X-ray absorptiometry (DXA) in predicting the fracture risk; (2) the use of next-generation sequencing (NGS) for the diagnosis of primary bone fragility; (3) the effectiveness of bisphosphonates in reducing fracture risk and improving clinical outcomes; and (4) the role of calcium and vitamin D supplementation in fracture prevention. These recommendations, revised and approved by the Italian National Institute of Health (INIH), aim to provide clinicians with a structured and evidence-based approach to improve the early identification, diagnostic work-up, and management of pediatric patients with bone fragility, promoting standardized care and reducing variability in clinical practice.
Authors
- Marco Pitea
- Barbara Predieri (ORCID: https://orcid.org/0000-0002-3302-6886)
- Domenico Corica (ORCID: https://orcid.org/0000-0002-3628-1612)
- Luisa De Sanctis (ORCID: https://orcid.org/0000-0003-2113-6196)
- Gianluca Aimaretti (ORCID: https://orcid.org/0000-0002-6186-0106)
- Giampiero I. Baroncelli (ORCID: https://orcid.org/0000-0001-8465-5087)
- Alessia Angelelli (ORCID: https://orcid.org/0000-0002-1059-7029)
- Natascia Di Iorgi (ORCID: https://orcid.org/0000-0002-4492-4585)
- Stefano Mora (ORCID: https://orcid.org/0000-0002-4781-6715)
- Anastasia Ibba (ORCID: https://orcid.org/0000-0002-6899-3884)
- Maria Felicia Faienza (ORCID: https://orcid.org/0000-0002-1899-8337)
- Basilio Pintaudi (ORCID: https://orcid.org/0000-0002-5657-5183)
- Valentino Cherubini (ORCID: https://orcid.org/0000-0002-7664-1475)
- Fabio Verdoni (ORCID: https://orcid.org/0000-0002-8544-5847)
- Laura Concas
- Elisa Sala (ORCID: https://orcid.org/0000-0001-5474-9293)
- Luca Savarino
- Maria Rosaria Licenziati (ORCID: https://orcid.org/0000-0001-6699-2231)
- Danilo Fintini (ORCID: https://orcid.org/0000-0002-0103-7951)
- Giovanni Iolascon (ORCID: https://orcid.org/0000-0002-0976-925X)
- Flavia Pricci (ORCID: https://orcid.org/0000-0002-1877-4376)
- Roberto Franceschi (ORCID: https://orcid.org/0000-0002-2230-7148)
- Silvia Deaglio (ORCID: https://orcid.org/0000-0003-0632-5036)
- Anna Grandone (ORCID: https://orcid.org/0000-0002-6343-4768)
- Antonio Stefano Salcuni (ORCID: https://orcid.org/0000-0002-0131-8681)
- Rino Agostiniani (ORCID: https://orcid.org/0000-0002-6800-6412)
- Donatella Capalbo (ORCID: https://orcid.org/0000-0003-3312-8628)
- Marco Sessa (ORCID: https://orcid.org/0009-0004-5305-5133)
- Enza Mozzillo (ORCID: https://orcid.org/0000-0002-8437-8494)
- Daniele Tessaris (ORCID: https://orcid.org/0000-0002-6484-4371)
- Fortunato Lombardo (ORCID: https://orcid.org/0000-0002-7081-5884)
- Leonardo Panzeri
- Mattia Cravino
- Francesco D’Aniello
- Alberto Falchetti
- Andrea Palermo
- Osama Al Jamal
- Giusi Umano
- Chiara Mameli
- Malgorzata Wasniewska
- Manuela Vaccarotto
Institutions
- University of Messina (IT)
- Università degli Studi del Piemonte Orientale “Amedeo Avogadro” (IT)
- Vita-Salute San Raffaele University (IT)
- University of Milan (IT)
- University of Campania "Luigi Vanvitelli" (IT)
- Istituto Superiore di Sanità (IT)
- Ospedale del Ceppo (IT)
- Istituto Giannina Gaslini (IT)
- Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT)
- Ospedale Santa Chiara (IT)
- Azienda Sanitaria Unità Locale di Reggio Emilia (IT)
- ASL Roma (IT)
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT)
- Istituto Clinico Sant'Ambrogio (IT)
- Department of Medical Sciences (RU)
- Istituto Ortopedico Gaetano Pini (IT)
- Agenzia Regionale Sanitaria della Puglia (IT)
- Federico II University Hospital (IT)
- Federazione Medico Sportiva Italiana (IT)
- Associazione Italiana per l'Agricoltura Biologica (IT)
- Bambino Gesù Children's Hospital (IT)
- Santobono Children's Hospital (IT)
- Ospedale Santa Maria della Misericordia di Udine (IT)
- Ospedale Microcitemico (IT)
- University of Campania "Luigi Vanvitelli" (IT)
- Department of Medical Sciences (BY)
- Associazione Regionale Allevatori della Lombardia (IT)
- IRCCS Ospedale San Raffaele (IT)
- Ospedale Regina Margherita (IT)
- Campus Bio Medico University Hospital (IT)
- Istituti di Ricovero e Cura a Carattere Scientifico (IT)
- Ospedali Riuniti Umberto I (IT)
- Azienda Ospedaliera Universitaria Pisana (IT)
- University of Bari Aldo Moro (IT)
- University of Naples Federico II (IT)
Publication Details
- Journal
- The Italian Journal of Pediatrics/Italian journal of pediatrics
- Published
- 2026-09-11
- DOI
- https://doi.org/10.1186/s13052-026-02324-4
- Primary Topic
- Bone health and osteoporosis research
- Type
- article
- Field-Weighted Citation Impact
- 0.00