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21 October, 2019 00:00 00 AM

An overview of juvenile osteoporosis

An overview of juvenile osteoporosis


Osteoporosis a progressive bone disease where bone density is lost or there is insufficient bone formation. The result is weakened bones and susceptibility to fracture. Osteoporosis is more common in older adults—especially menopausal and post-menopausal women—but it can also affect children, in which case it's called juvenile osteoporosis. This rare form of osteoporosis typically occurs just before the onset of puberty in previously healthy children. The average age at onset is seven years, with a range of one to 13 years.

Osteoporosis can be a serious problem for young people because it strikes at a time where they are building most of their bone mass. Losing bone mass during this very crucial time can put a child at risk for some very serious complications, including fractures.

The first sign a child has osteoporosis is pain the low back, hips, and/or feet.  The child may also have difficulty walking or walk with a limp. Fractures of the lower extremities are common, especially of the knee or ankle.

Juvenile osteoporosis may also cause physical deformities, including:
Sunken chest
Loss of height
Abnormal curvature of the thoracic spine, a condition called kyphosis. The thoracic spine connects the cervical spine above the lumbar spine below. It runs down the base of the neck to the abdomen and is the only part of the spine connected to the rib cage.

Osteoporosis in children is rare, but it is often caused by an underlying medical condition. There are two types of juvenile osteoporosis: secondary and idiopathic.
A diagnosis of idiopathic juvenile osteoporosis is made when the cause of the disease is not identified.

Secondary Juvenile Osteoporosis
Secondary osteoporosis is more common than idiopathic juvenile osteoporosis, but an exact prevalence is unknown. Secondary juvenile osteoporosis usually caused by another medical condition.

Some of the diseases that may lead to secondary juvenile osteoporosis in a child include:
Juvenile arthritis (JA): Different types of JA have disease processes that contribute to the development of osteoporosis. For example, studies in children with juvenile idiopathic arthritis have bone mass than is lower than expected, especially joints affected by arthritis.1 Other studies show that drugs used to treat JA, such as prednisone, can negatively affect bone mass. Further, some behaviors related to JA, such as avoiding physical activity due to pain, can also reduce bone strength and bone mass.

Type 1 diabetes: Type 1 diabetes, a type of diabetes where is the body produces too little or no insulin, is common in children and young adults. People with Type 1 diabetes often have poor bone quality and increased risk for fractures.2 With the onset of Type 1 diabetes in younger people, when bone mass is still increasing, the risk is increased for a child developing secondary osteoporosis.
Cystic fibrosis (CF): CF is a progressive, genetic condition that causes recurrent and ongoing lung infections, and eventually limits the ability to breathe over time. Lung disease can slow down puberty and hinder a child’s bone growth and slowed puberty will eventually lead to weaker bones.3

Malabsorption diseases: Malabsorption from bowel diseases (e.g. Crohn’s disease, celiac disease, etc.) can reduce the absorption of nutrients from intestines, including calcium from diet and vitamin D. This can increase bone loss and lead to fractures.

Female athlete triad syndrome: This condition can also lead to osteoporosis in young women. It is caused by a combination of lack of energy, poor eating and missed periods.

Medications can also lead to secondary juvenile osteoporosis, including chemotherapy drugs, anti-convulsant medications, and corticosteroid drugs. If your child has cancer, seizures, or arthritis, you may want to talk to his or her doctor about checking bone density.

Lifestyle: Sometimes, juvenile osteoporosis is related to certain behaviors, such as prolonged immobility or inactivity. Inadequate nutrition—especially lack of vitamin D and calcium—may also contribute to juvenile osteoporosis.

Idiopathic juvenile osteoporosis
While there are no known causes for idiopathic juvenile osteoporosis, researchers have confirmed that genetics play a part in early-onset osteoporosis that isn’t secondary. For example, mutations of certain regulatory proteins have been linked to early-onset osteoporosis with axial (spinal) and appendicular (limbs) fractures during childhood.

Idiopathic juvenile osteoporosis is less common than secondary.  It seems to affect more boys than girls. It also starts before puberty, with an average onset of 7 years of age.  
With this type of osteoporosis, your child’s bone density may recover during puberty. However, bone density will still not be as normal when bone mass peaks later into adulthood.

A diagnosis of juvenile osteoporosis can be a hard diagnosis to make. Bone density scans are the most accurate way to determine lowered bone mass early, but scanning can only be done once your child’s doctor suspects juvenile osteoporosis. These scans look at bone mineral content and skeletal changes, including bone loss. These tests, however, are not always accurate and need to be looked at carefully in order to make an osteoporosis diagnosis.

Instead, your child’s doctor will rely on signs and symptoms that indicate your child may have fragile bones. This includes pain in the lower back, hips, and feet, accompanied by problems with walking. Knee and ankle pain and fractures may be a symptom.

If a child isn’t exhibiting symptoms, a diagnosis is usually made when a child has broken bone. In addition to bone density scanning, X-rays can also show low bone density, fractures, or a collapsed or misshaped vertebra (bones of the spinal column). Unfortunately, X-rays won't detect osteoporosis until there has been a significant bone mass loss.
Newer types of X-ray, including dual-energy X-ray absorptiometry (DXA), dual photon absorptiometry (DPA), and quantitative computed tomography (CAT scans), can help with an earlier and more accurate diagnosis of low bone mass.

Juvenile osteoporosis vs. osteogenesis imperfecta
Osteogenesis imperfecta (OI) is a rare genetic disorder. Much like juvenile osteoporosis, it is known for causing weak bones that are susceptible to fracture. It is caused by problems with the quantity and quality of bone collagen.

Bone collagen is a hard, insoluble, and rubbery protein found in bones, muscles, skin, and tendons. Children who have OI will not achieve normal bone mass.5 This condition ranges from mild to severe.

Features of OI include:
Bones that fracture easily
Bone pain
Loose or hypermobile joints (joints that have a higher range of mobility)
Low muscle strength
Family history
Small stature, especially in moderate to severe cases
Sclera, a condition where the whites of the eyes are tinted to blue, purple or grey
Possible hearing loss
Possible brittle teeth, a condition called dentinogenesis imperfecta
The two main features of OI that make it distinguishable from juvenile osteoporosis are family history and sclera. In some cases, distinguishing OI from juvenile osteoporosis may require genetic testing.

Once your child has a diagnosis, your child’s doctor will want to develop a specific treatment plan. Treatment is usually aimed at protecting the spine and other bones from fracture.6 It is also based on the severity of the disease.

Similar to their peers, children with secondary osteoporosis need a diet rich in vitamin D and calcium. They also should get as much physical activity as possible given the limits of their health.
Treating the source
Treatment mainly depends on the cause of osteoporosis symptoms. With secondary juvenile osteoporosis, your child’s doctor will want to identify and treat the underlying cause.

If an underlying medical condition is the source, this will include diagnosing and treating that disease. With medication-induced juvenile osteoporosis, it is best to treat the primary condition with the lowest effective medication dose or find an alternative and effective treatment.

You should encourage your child to take part in regular exercise. Ask your family pediatrician for a referral to a physiotherapist or exercise physiologist. This person can help create an exercise program that promotes bone health, is safe, and reduces the risk for fractures.

You will want your child to be active, but it is a good idea to avoid sports where your child could easily get injured, such as contact sports.

Calcium and vitamin D
Since calcium is an important part of bone health, adding more calcium to your child’s diet can increase bone strength and reduce fracture risk. Good dietary sources of calcium include dairy (milk, yogurt, cheese, etc.) leafy green vegetables, and calcium-fortified foods. A dietitian can be a great source of information for increasing calcium in your child’s diet.
You should also make sure your child is getting enough vitamin D because this vitamin increases the absorption of calcium and makes bones stronger. We get most of our vitamin D exposure from the sun, so make sure your child is exposed to sunlight daily. If you are concerned your child is not getting enough vitamin D, talk with their doctor.

Your child may need medication to manage symptoms. This may include pain medications after a fracture or, if a child has severe osteoporosis, medications to encourage bone strength. These including fluoride, calcitonin, and bisphosphonates.
Your doctor is in the best position to determine what medication options might best work for his or her unique situation. Your child’s doctor may also prescribe calcium or vitamin D supplements if your child is not getting enough from diet or sunlight exposure.

Long-term problems
Untreated juvenile osteoporosis can lead to long-term problems. This is because, throughout childhood, children build up their peak bone bass. This is usually accomplished before age 30.
The more bone a person has, the stronger their bones are. Strong bones also reduce the risk of osteoporosis later in life.

Without treatment, juvenile osteoporosis can affect bone strength and density, and also increase the potential for osteoporotic fractures later in life. That is why early diagnosis and treatment of juvenile osteoporosis are important.

A word from verywell
You can promote healthy bone habits in your children by encouraging proper nutrition and plenty of exercise.
Eating for bone health means getting plenty of foods that are rich in calcium and vitamin D, including dairy, calcium-rich fruits, and leafy vegetables, nuts and seeds, and some types of oily fish (i.e. sardines and salmon). You should also try to limit children’s access to soft drinks and snacks that don’t provide calcium. Help your kids find a variety of physical activities they can enjoy participating in and establish limits for sedentary activities, such as watching TV and playing video games.

Another good way to promote your children’s bone is health is by being a good role model. Drink milk with meals, snack on calcium-rich foods, and get plenty of exercise. Don’t smoke.
You may not realize it, but your children are watching, and your habits—good and bad—have a strong influence on them now and into the future.



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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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