Osteoporosis (Children)

Osteoporosis is a disease that causes bones to become less dense and more prone to fractures. It is usually a condition seen in elderly people but can occur in children as well. Not all fractures are due to Osteoporosis. Some are the result of high impact trauma in a child with healthy bones.

Building healthy bones by adopting healthy nutritional and lifestyle habits in childhood is important to help prevent Osteoporosis and fractures later in life. Bone mass is slowly built up during childhood and adolescence and reaches its peak by the age of late twenties. Building your children's "bone bank account" is a lot like saving for their education. The more they can put away when they are young, the longer it should last as they get older. The health habits your kids are forming now can make or literally break their bones as they age.

Peak bone mass is influenced by a variety of factors. There are some factors like gender and race that you cannot change and others like nutrition and physical activity that you can.

Some examples are:

• Gender: Bone mass or density is generally higher in men than in women.
• Race: African American girls tend to achieve higher peak bone mass than Caucasian girls and thus are at lower risk for Osteoporosis later in life. Asian girls tend to have a smaller build and lower bone mass, and therefore have a higher risk for Osteoporosis.
• Hormonal factors: Sex hormones, including oestrogen and testosterone, are essential for the development of bone mass.
• Nutritional status: Calcium and vitamin D are essential nutrients for bone health.
• Physical activity: Physical activity is important for building healthy bones.

Two or more low impact fractures may be a sign of a disorder. If you are concerned about your child's frequent fractures, talk to his or her doctor for more information.

If your child has a medical condition that may interfere with bone mass development, ask the doctor for ways to minimise the problem and protect your child's bone health.

You can see a paediatrician specialising in endocrinology to help assess your child's bone health and whether his or her fractures are due to poor bone mass.

Osteoporosis is rare in children and adolescents. When it does occur, it is usually caused by an underlying medical disorder or by medications used to treat such disorder. This is called secondary Osteoporosis. It may also be the result of a genetic disorder such as Osteogenesis Imperfecta (Brittle Bone Disease).

Any systemic disease that a child has may increase his or her risk of having secondary Osteoporosis. A systemic disease refers to a disease that affects part or whole of the body.

Children with certain health conditions and/or taking some medications may be at higher risk.

Conditions that increase the risk of Osteoporosis:

• Rheumatological conditions like Juvenile Arthritis or Lupus
• Neuromuscular disorders like Cerebral Palsy, Duchenne Muscular Dystrophy, Immobilisation
• Endocrine conditions like Hyperthyroidism, Hyperparathyroidism, Cushing's Syndrome, Delayed Puberty
• Malabsorption Syndromes
• Anorexia Nervosa
• Kidney disease
• Liver disease

Medications that increase the risk of having Osteoporosis:

• Some anticonvulsants (e.g. for epilepsy)
• Corticosteroids (e.g. for rheumatoid arthritis, asthma)

Behaviours that increase the risk of having Osteoporosis:

• Prolonged inactivity or immobility
• Inadequate nutrition, especially calcium and vitamin D
• Excessive exercise leading to amenorrhoea

You may want to speak to your child's doctor or see a paediatrician specialising in endocrinology to find out if your child has an increased risk.

Treatment will depend on the cause of the problem and needs to be discussed individually.

• It is important to have proper nutrition and plenty of physical activity.
• Try to encourage your child to take plenty of food that are rich in calcium and vitamin D.
• Any kind of physical exercise is great for children but the best ones for their bones are weight-bearing activities like walking, running, hiking, dancing, tennis, basketball, gymnastics and soccer. Children who tend to play outside will also have higher vitamin D levels.
• To reduce the risks of Osteoporosis, you can also help by limiting his or her caffeine and alcohol intake and advise him or her to avoid smoking.
• One of the best ways to encourage healthy habits in your children is to be a good role model yourself. Your kids are watching and following your habits, both good and bad.