Making Old Bones: when children develop osteoporosis

Osteoporosis is probably one of the last diseases we would expect a child to suffer. We are so used to it as a bone thinning disease of older people that when presented with it in a really young person, even babies, there is almost a sense of shock along with the concern. But rather unfortunately, it is recognised as a paediatric problem as well.

Reason and circumstance

There are many reasons why a child can develop osteoporosis – often it arises as a secondary disease to other illnesses or treatments. It can be surprising to note that vertebral compression fractures are quite common and often underdiagnosed in children with secondary osteoporosis.

The most common primary bone disorder leading to bone thinning in young people is osteogenesis imperfecta – a structural genetic defect in the quantity or quality of bone collagen production. Family history plays a primary role in this cause.

Other conditions may include: idiopathic juvenile osteoporosis and osteoporosis-pseudoglioma syndrome. Inflammatory levels, corticosteroid use, and various endocrine disorders can also play a role in the development of this condition in young people.

But before we go into a list of jaw-stretching medical terms, we must understand that osteoporosis at whatever age is going to cause weakening of the bones, and a greater likelihood of fractures. Children between the ages of 8 and 14 are most likely to show these symptoms early on because of the active lifestyle of youngsters in the rough and tumble of play and sport. The presence of multiple fractures at this age should be checked out for the possibility of osteoporosis.

While an older person can take various precautions and live a more sedate life to preserve their bones as best they can, for a young person it’s a serious diagnosis because it is precisely at this age that children are expected to build up their bone strength. By the ages of 18 or 20, the individual is expected to have built up at least 90% of their bone strength – a sobering thought for those youngsters unable to do this because of early onset of osteoporosis. Bone mass built during prime bone-building years is expected to last a lifetime, and hopefully – if taken good care of – well into old age.

Because the risk of fractures is so high with what can be a silent disease, when a child complains of pain in the lower back, hips, knees, ankles or feet – or has trouble walking – it’s time to take tests to ascertain the cause of the problem as soon as possible.

Juvenile osteoporosis is sometimes hard to define from described symptoms, or even a fracture, so the best process of examination should include a bone density scan. This is probably the most accurate way to confirm the condition, but even so, diagnosis must be clearly and carefully interpreted in young children and preferably by an expert in the bone field.

Treatment and actions

Medication can be tricky. Unfortunately, none of the osteoporosis drugs approved for adults are suitable for use in children. Treatment with bone-active agents, such as bisphosphonates, should be conducted only under close medical supervision for children who present with metabolic bone diseases.

Care and diet are probably the best routes to take. It’s crucial to protect the child’s bones if the skeletal structure is found to be osteoporosis-positive. Avoiding contact sports, certain types of exercise or too rigorous exercise is important.

However, all children, including those with juvenile osteoporosis, need a lifestyle that helps build healthy bones. For those with a diagnosis of osteoporosis, or a predisposition, this becomes an important focus of lifestyle. Key focus should be: a diet rich in calcium and protein; plenty of Vitamin D when the sun shines; maintaining a healthy weight level.

  • Calcium: is an essential component of bone tissue and required for normal mineralisation of the bone matrix. Recommended intake of calcium varies in different age groups and countries, but children with osteoporosis may need over 1,000 mg of calcium supplements daily.
  • Vitamin D: deficiency can result in a decrease in uptake of dietary calcium and phosphorous. Recommended daily dose of Vitamin D2 or D3 is 600 IU for children (aged one to 18 years) who are at risk of due to inadequate exposure to sunlight, malabsorption syndromes and treatment with anticonvulsants.

If a child’s osteoporosis is caused by external elements such as another disease or medication for something unrelated, then treatment may simply mean changing the medication or treating the primary complaint efficiently. A child’s structure is resilient and clearing the problem causing the thinning of bone may be all that is required, because then the natural process of restoring and building bone will begin.

While taking every care with physical activity, this cannot be stopped entirely – because conversely exercise is good for osteoporosis provided it is carefully planned and executed, with weight-bearing exercise a prime positive factor.

Love dem bones! They come in all shapes and sizes – but stand by you every day.

NOFSA (National Osteoporosis Foundation South Africa)

NOFSA is the only non-profit, voluntary health organisation dedicated to promoting lifelong bone health. We focus on reducing the widespread prevalence of osteoporosis while working to find a cure for the disease, and by supporting research and developing programmes of education and advocacy.

Find out more about our work at: www.osteoporosis.org.za