A correct approach to low bone mass in adolescents with rheumatic diseases should always start with the simplest measures, that is, correct calcium intake and a physical activity program. Whenever serum vitamin D levels are inappropriately low, active metabolites of vitamin D should be initially used. Among more specific drugs, only bisphosphonates have been consistently used, especially in the presence of a high fracture risk, even if only a few studies have been carried out in young patients.
Of course, after a therapy for bone loss has been started, accurate periodical evaluation is required. This should include clinical history and examination (growth, presence of pain, kyphosis, fractures) as well as a thorough study of bone mass and bone turnover, which are essential instruments to evaluate treatment efficacy.
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