Medication-Related Impacts on Pediatric Bone Health

Bone health during childhood and adolescence is crucial because this is when individuals develop most of their lifetime bone mass. Disruptions in bone metabolism during these years, especially those caused by medications, can have long-lasting effects. Many drugs routinely prescribed to children, including glucocorticoids, antiepileptics, chemotherapeutic agents, and psychotropic medications, have been shown to harm bone development. These effects include lower bone mineral density (BMD), impaired bone growth, and a higher risk of fractures. However, specific medications can help strengthen bones in high-risk children. Bisphosphonates, commonly used in treating osteogenesis imperfecta and glucocorticoid-induced osteoporosis, have proven effective in increasing BMD and lowering fracture rates. These drugs slow bone resorption and are generally well tolerated in children, with few serious long-term side effects. Pediatricians and other child health providers play a key role in identifying children at risk for poor bone health and in implementing preventive strategies. Given the lifelong implications of suboptimal bone health, the purpose of the review is to summarize the skeletal effects of medications, which should be an integral part of pediatric care. Key Concepts: (1) Many commonly prescribed pediatric medications, such as glucocorticoids, antiepileptics, and psychotropics, can significantly impair bone development and increase fracture risk.(2) Medication-induced bone loss in children can occur through multiple mechanisms, including impaired osteoblast activity, altered calcium or vitamin D metabolism, and hormonal disruption.(3) Preventive strategies such as optimizing nutrition, promoting weight-bearing activity, and screening high-risk patients can mitigate bone loss during long-term therapy.(4) Bisphosphonates can be effective in treating pediatric osteoporosis but should be reserved for select cases and managed under the supervision of healthcare providers.(5) Coordination between pediatricians and other healthcare specialists is essential to ensure bone health is considered in the context of chronic medication use.