Calcitonin inhibits bone resorption by osteoclasts and has been shown to reduce the risk of new vertebral fractures in adult patients. It can be administered by injection or intranasally. There is only one published study in 10 children with JIA, which showed a decrease in bone resorption markers and an increase in BMD (7.2 ± 9.5%/year) (72).
Teriparatide (recombinant human parathyroid hormone, hPTH 1-34) is a relatively new drug, with unique anabolic properties on bone. While the majority of drugs used in osteoporosis are antiresorptive agents, teriparatide mainly stimulates bone formation. It is used in adult patients, also in glucocorticoid-induced osteoporosis (73,74). There are no published studies on its efficacy and safety in children. Great caution is recommended, since pharmacological stimulation of bone formation in the growing age might increase the risk for osteosarcoma.
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