Secondary forms of osteoporosis can be found in a variety of other illnesses (Table 1).
Secondary osteoporoses are constantly increasing in the young for several reasons, such as the longer survival in many severe chronic diseases, the greater pediatric use of potentially bone-damaging drugs, and—last but not least—the greater attention now paid to the alterations of bone and mineral metabolism.
In all forms of secondary osteoporosis in addition to the direct bone derangements caused by the primary disease malnutrition, reduced dietary intake of calcium, protein and vitamin D, limited physical activity, reduced exposure to sunlight, all contribute to alter the skeletal growth and development and the acquisition of bone mass.
Among the most frequent causes of osteoporosis also in pediatric age, we must remember long-term glucocorticosteroid (GC) treatment. Many studies have demonstrated that GCs induce osteoporosis, compromise the attainment of a normal peak of bone mass, and increase the fracture risk even in the young (30). A negative correlation between cumulative steroid dose and bone mass has been demonstrated, particularly in children (31,32). Much discussed are the possible effects on bone mass of inhaled corticos-teroids (33), a significant problem considering the increasing incidence of asthma in the young.
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