Aman Pulungan, Ghaisana Fadiana and Fahreza Aditya Neldy
OBJECTIVE: Osteoporosis in children and adolescents recognized with certain unique diagnostic and clinical challenges. Impaired mobility, inadequate nutrition, hormone disruption and medication use (e.g., glucocorticoid) are all factors that affect bone size and microarchitecture and impair bone mineralization. Osteoporosis is defined as “decreased bone strength that predisposes individuals to fragility fractures. Diagnosis of osteoporosis requires both a history of pathologic fractures and low bone mineral density or content. Bisphosphonate therapy is proven to reduce the odds of having new fractures. Aim of this study is to raise awareness of osteoporosis in pediatric population as well as preventive and therapeutic strategy. CASE: A fourteen-year-old girl was diagnosed with pemphigus vulgaris and received steroid and immunosuppressant therapy since November 2018. She was a lacto-ovo-vegetarian. After eight-month of steroid therapy, patient started to complain recurrent back pain. Spine x-ray examination was done and revealed vertebral compression fracture in L2 with 22% height loss. Total body BMD was 0,86 g/cm 2 (Z-score: -2.1) and area BMD of L1-L4 spine was 0.696 g/cm 2 (Z-score: -2.5). There is no abnormality of sex and thyroid hormones. The patient was advised to wear lumbosacral braze and planned to have bisphosphonate therapy. As the disease progressed, the patient was unable to move and had to lying on the bed due to severe pain. Lumbosacral MRI examination showed mild to severe compression in multiple level of vertebrae. The patient was given bisphosphonate (0.1 mg/kg/year), vitamin D and calcium supplementation. No adverse events (e.g., hypocalcemia) were found during and after bisphosphonate administration. After 3-4 months the patient now has been able to sit with support. CONCLUSION: Patients with steroid therapy are at risk of having osteoporosis and pathological fracture. Dietary intake that rich in vitamin D and calcium, micronutrient supplementation and zoledronate acid may prevent those conditions.