Grant: Team Grant: Bone Health - LOI

Osteoporosis (bone fragility) is a potential consequence of serious childhood illness or its treatment. Fractures can significantly impact the quality of life of the child battling serious illnesses; furthermore, inadequate bone development in childhood has been linked to osteoporosis later in life. We propose two over-arching goals to address the needs of Canadian children with bone disorders. The first goal is to enhance the diagnostic tools available for the care and study of children with bone disorders by developing quality, population-based normative data for key clinical outcomes. The second goal is to implement effective prevention and treatment strategies for osteoporosis secondary to serious pediatric illnesses. This will be exemplified by two model diseases, Duchenne muscular dystrophy (DMD) and Crohn's disease, that are united by their potent risk factors for osteoporosis - glucocorticoid use and muscle weakness. These disorders also share the potential for significant bone morbidity and lack of cure for the underlying condition. In DMD, we will compare two commonly used osteoporosis agents to determine which agent is most effective in the treatment of DMD-related osteoporosis. In addition, we will conduct a natural history study in boys with DMD from the time of glucocorticoid initiation, to inform the design of a future osteoporosis prevention trial in this condition. We will also test novel osteoporosis agents in the pre-clinical (i.e. growing DMD mouse model) setting, to inform their use in future clinical trials. In children with Crohn's disease, we will evaluate the impact of exercise intervention to improve muscle and thereby bone strength. This research will be paramount in addressing the pressing needs of children with bone disorders and will build further capacity for pediatric osteoporosis research in Canada.