Ann Pediatr Endocrinol Metab.  2023 Mar;28(1):34-41. 10.6065/apem.2244026.013.

Factors affecting bone mineral density in children and adolescents with secondary osteoporosis

  • 1Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea


This study aimed to investigate the clinical factors associated with bone mineral density (BMD) among children and adolescents with osteoporosis secondary to treatment for underlying clinical conditions.
We retrospectively reviewed the medical records of patients aged 10–18 years and evaluated them for lumbar spine BMD (LSBMD) after treatment for underlying diseases, including hemato-oncologic, rheumatologic system, and inflammator y bowel diseases. LSBMD measured by dual-energy x-ray absorptiometry (DXA) performed from March 2019 to March 2021 was evaluated. We analyzed 117 patients who underwent initial DXA after treatment for underlying diseases.
Subjects in this study had multiple underlying diseases: hemato-oncologic (78.6%), rheumatologic (11.1%), and inflammatory bowel diseases (10.3%). There was no significant association between the z-score and bone metabolic markers (P>0.05). However, higher cumulative glucocorticoid (GC) dose significantly reduced LSBMD z-score (P=0.029). Moreover, the association between cumulative dose of GC and initial z-score of LSBMD was significant in logarithmic regression analysis (P=0.003, R2=0.149). GC accumulation was a significant risk factor for vertebral fracture when the initial BMD was evaluated after treatment (P=0.043). Bone metabolic markers did not significantly influence the risk of vertebral fracture.
Initial bone mass density of the lumbar spine evaluated after long-term GC use for underlying diseases is a predictor of further vertebral fractures.


Secondary osteoporosis; Bone mineral density; Dual-energy x-ray absorptiometry


  • Fig. 1. Association between glucocorticoid (dosage and duration) and initial lumbar spine bone mineral density (LSBMD). (A) A scatterplot of initial LSBMD according to cumulative glucocorticoid dosage. A solid line indicates a nonlinear regression line, and a dashed line indicates a linear regression line. A negative association was observed between initial LSBMD and cumulative glucocorticoid dosage; statistical significance was observed only in the logarithmic regression model (R2=0.149 and P=0.003 in logarithmic regression model, R2=0.043 and P=0.117 in linear regression model). (B) A scatterplot of initial LSBMD according to duration of glucocorticoid use. A solid line indicates a nonlinear regression line, and a dashed line indicates a linear regression line. A negative association was shown between duration of glucocorticoid use and initial LSBMD; the logarithmic regression model explained the association better than the linear regression model (R2=0.103, P=0.014 in logarithmic regression model and R2=0.070, P=0.044 in linear regression model).

  • Fig. 2. Receiver operating characteristic curve for initial lumbar spine bone mineral density in discrimination of follow-up osteoporosis. The area under the curve was 0.715 (95% confidence interval, 0.514–0.917). Youden index was used to determine the optimal cutoff point. AUC, area under the curve.



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