Childhood Osteoporosis: Screening, Prevention, Treatment, and Safe Handling Practices in a Tertiary Care Pediatric Hospital

Osteoporosis is a challenge facing children of all ages with multiple different health conditions and physical abilities. The reality of this challenge stemmed the development of the child health program's interdisciplinary bone health project team in a tertiary care, in-patient pediatric hospital. The committee's goal was to develop protocols and tools to help identify at-risk children and ultimately prevent fragility fractures in these children. An evidence-based screening tool was developed to allow primary caregivers to quickly recognize the child who is most at risk for osteoporosis and determine the next step to take related to bone health. The use of standardized evidence-based diagnosis, treatment, and prevention protocols empowers all care providers to make bone health a priority for their patients. A “handle with care” protocol, along with identifiable signage, gives caregivers and others who may handle the child the ability to do so safely, with adequate knowledge of fracture prevention strategies. A resource for families and caregivers, which includes the definition of pediatric osteoporosis, diagnostic criteria, and prevention strategies, has been developed. Nutrition and lifestyle recommendations, including activities of daily living, safe handling practices, and tips to prevent injury, are also included. All children admitted to the children's hospital are screened during their admission using a standard nursing database with a specific bone health screen added. The process from screening to initial workup, diagnosis, and treatment or prevention arm will be described in detail. Any child identified as high risk or having pediatric osteoporosis will be automatically entered in the “fragile: handle with care” protocol. This multidisciplinary approach to bone health and fracture prevention is the key to successful outcomes for all children at risk for osteoporosis. Roll-out and sustainability of this project have depended greatly on networking and collaboration with many stakeholders from initiation through to maintenance of this practice change. A working component is to expand screening and fracture prevention methods by identifying children with osteoporosis in the community through education of professionals and families.