Osteoporosis in children

Osteoporosis causes bones to become weak and lose their strength, so they break more easily than healthy bones. While osteoporosis is most common in older people, especially in women after menopause, it can also affect children.

When the condition occurs in children it is called juvenile osteoporosis. This is rare. In most cases it is caused by an underlying medical condition, by certain medicines used to treat a medical condition, or by lifestyle factors. When there is an identifiable cause like this, it is known as secondary osteoporosis.

Less commonly, osteoporosis develops in a child for no known reason. This is called idiopathic juvenile osteoporosis.

How healthy bones develop#

Our bones are living tissue that is constantly growing, rebuilding, replacing and repairing itself. From the time we are born until about 25 years of age, we build more bone than we lose. This helps us grow and develop a strong skeleton to support us throughout life. Our peak bone mass is built up during childhood and is usually reached before the age of 30.

In children with juvenile osteoporosis this process is altered. Not enough bone is built, or too much bone is lost, or both happen together. As a result, bones become less dense, lose strength and break more easily.

Causes of juvenile osteoporosis#

Juvenile osteoporosis can occur at any age. In most cases it is linked to an underlying medical condition, a medicine used to treat a condition, or a lifestyle factor.

Medical conditions that may be involved include:

• juvenile idiopathic arthritis
• osteogenesis imperfecta
• diabetes
• kidney disease
• hyperthyroidism
• Cushing’s syndrome
• inflammatory bowel disease
• cystic fibrosis
• anorexia nervosa

Medicines that may contribute include:

• some types of cancer treatment
• anticonvulsant medicines used to manage epilepsy
• corticosteroids used to treat a wide range of conditions, including arthritis and asthma

Lifestyle factors can also play a part. Children who are bedridden or have prolonged periods of immobility are at increased risk, because they are unable to take part in weight-bearing activities that encourage bone density. Inadequate dietary intake, smoking and alcohol can also contribute.

Diagnosing juvenile osteoporosis#

Juvenile osteoporosis is often diagnosed after a child has broken a bone. To investigate, a doctor may use:

• a medical history
• a physical examination
• the medical histories of family members, to find out whether a genetic disorder is the cause
• a bone scan, using dual energy x-ray absorptiometry (DEXA) to measure bone density
• blood tests

Idiopathic juvenile osteoporosis#

Sometimes no underlying cause can be found. In these rare cases, the condition is called idiopathic juvenile osteoporosis.

A child with this condition tends to have symptoms such as pain in the lower back, hips and feet, often with difficulty walking and changes in the shape of the spine. Generally, idiopathic juvenile osteoporosis resolves on its own, and most children make a complete recovery of bone tissue. In some children, however, disability may continue into adulthood. The reason for this is not known.

Long-term risks#

The more bone mass we build, the stronger our bones are and the lower the risk of osteoporosis later in life. Without treatment, juvenile osteoporosis can affect the strength of a child’s bones and increase the risk of osteoporosis and fractures in later life. That is why diagnosing and treating it as early as possible is so important.

Treating juvenile osteoporosis#

In most cases juvenile osteoporosis can be treated. Treatment depends on the cause but may include:

• diagnosing and treating an underlying medical condition
• changing medication if a medicine is the cause; a doctor may lower the dose or prescribe a different medicine
• encouraging regular, appropriate exercise; a physiotherapist or exercise physiologist can help create a program that promotes bone growth, is safe and does not risk a fracture
• increasing calcium in the diet, including dairy products (such as milk, cheese and yoghurt) and other sources such as leafy green vegetables, tofu, nuts and legumes, as well as calcium-fortified foods such as soy milk
• making sure the child gets enough vitamin D
• taking calcium and vitamin D supplements if necessary, after discussion with a doctor
• protecting the child against fractures, for example by avoiding contact sports
• medication, which may be needed to help manage symptoms such as pain after a fracture

A dietitian can give advice on practical ways to increase calcium in a child’s diet.

Vitamin D and sunlight#

We obtain most of our vitamin D from sunlight on the skin, so it helps for a child’s skin (such as the hands, face and arms) to be exposed to some sun. The amount of safe sun exposure needed for enough vitamin D depends on the child’s skin type, where they live and the time of year. A shorter period is generally needed in warmer, sunnier weather, while a longer period may be needed in cooler weather; it is best to avoid the hottest part of the day. For most people it is unlikely that enough vitamin D can be obtained from diet alone.

If you are not sure whether your child is getting enough vitamin D, talk with your doctor.

Key points#

• Juvenile osteoporosis is rare and is usually caused by an underlying condition, a medicine or a lifestyle factor; less commonly it occurs for an unknown reason.
• It can be diagnosed after a child breaks a bone, sometimes with no underlying cause found.
• The more bone mass we build, the stronger our bones are and the lower the risk of osteoporosis later in life.
• Diagnosing and treating juvenile osteoporosis as early as possible is important to protect long-term bone health.

Where to get help#