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This review summarizes evidence on conditions commonly encountered in pediatric orthopedic practice, medical management strategies, and perioperative care for children with bone fragility.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Recent Findings<\/jats:title>\n                    <jats:p>Diagnostic approaches have been evolving toward integrating fracture characteristics, skeletal risk factors, and bone mineral density (BMD). A single low-trauma vertebral compression fracture is now sufficient for diagnosis of osteoporosis in children regardless of BMD. Intravenous bisphosphonates remain first-line therapy, with recent meta-analyses confirming consistent BMD gains and, observationally, a reduction in fracture risk. Bisphosphonates are generally given to children who have sustained low-trauma vertebral fractures and considered for other children with recurrent long bone fractures with low BMD. Early intervention with bisphosphonates may also be warranted for children with high-risk diseases, such as Duchenne\u2019s Muscular Dystrophy (DMD).<\/jats:p>\n                    <jats:p>Biologic agents are emerging in clinical trials and select specialized use, but further research is needed to understand their role in pediatric osteoporosis. Denosumab carries a substantial risk for rebound hypercalcemia in children with osteogenesis imperfecta (OI), limiting its use to selected indications. Preliminary reporting from a large trial of anti-sclerostin therapy in children with osteogenesis imperfecta suggests significant BMD increases while fracture-reduction endpoints were not met, underscoring the limitations of BMD as a surrogate in pediatric bone fragility trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>Providing optimal care for this unique group of patients requires multidisciplinary coordination amongst orthopaedic surgeons, endocrinologists, geneticists, and rehabilitation specialists. Evidence-based management includes preoperative bone health evaluation, procedure-specific modifications in fragile bone, nutritional optimization, and coordinated bisphosphonate timing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11914-026-00985-y","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T06:52:39Z","timestamp":1791269559000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Osteoporosis in Pediatric Orthopaedics: Congenital Diseases, Medical Management, and Perioperative Considerations"],"prefix":"10.1007","volume":"24","author":[{"given":"Aki S.","family":"Puryear","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura E.","family":"Bess","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda A.","family":"DiMeglio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"issue":"5","key":"985_CR1","doi-asserted-by":"publisher","first-page":"e2088","DOI":"10.1210\/clinem\/dgz294","volume":"105","author":"LM Ward","year":"2020","unstructured":"Ward LM, Weber DR, Munns CF, H\u00f6gler W, Zemel BS. 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