‘No Bone About It: Osteoporosis Is A Pediatric Disease’

 By Kaaren Valenta

Most people think of osteoporosis is a disease that adults get in later life, but osteoporosis actually is a pediatric problem, according to medical authorities.

Osteoporosis affects 28 million Americans. The National Osteoporosis Foundation estimates this number will increase to 41 million by 2015.

What many people do not realize is that 90 percent of bone growth occurs between the ages of 10 and 20. And while genetics, regular exercise, and vitamin D intake play a role in osteoporosis, so does the amount of calcium that children and teenagers have in their diets.

The US Surgeon General released his “Report on Osteoporosis and Bone Health” last month, suggesting that the recent rise in bone diseases among men and women of all ages and ethnicities is linked to the decline in the nutritional quality of American’s diets.

“Osteoporosis isn’t just your grandmother’s disease,” said Surgeon General Richard Carmona. “You are never too old or too young to improve your bone health.”

During childhood, calcium intake determines not only whether children will grow as tall as their full potential, but also how long their bones will last. And as life spans increase, getting enough calcium becomes even more important.

That message was delivered by Francisco A. Sylvester, MD, at the 19th annual Pediatrics Update Conference held recently at Danbury Hospital. An associate professor of pediatrics at the University of Connecticut School of Medicine, Dr Sylvester presented a seminar on “No Bone About It: Osteoporosis Is a Pediatric Disease.”

“Osteoporosis is characterized by a reduction in bone mass,” Dr Sylvester said. “Since osteoporosis is easier to prevent than to treat, the goal is therefore to identify individuals who might be at high risk.”

The problem is that tests used on adults generally involve radiation and are not ideal for testing children, he said. “It would be nice to have something that doesn’t involve radiation, but that is in the future.”

Children’s bones are growing and changing, which makes interpretation of tests more difficult, he said.

Measuring bone mass density is not indicated unless the results will influence a treatment or disease management decision,” he said. “The child should have a history of fractures or be on corticosteroids for more than three months.”

Most treatment strategies have been extrapolated from those used to treat postmenopausal osteoporosis, but “children are not small adults,” he said.

Dr Sylvester said the recommended calcium intake for children age 1 to 3 is 500 mg per day, according to the National Academy of Sciences, in a 1997 report. Children 4 through 8 need 800 mg, and children 9 through 18 need 1,300 mg for optimum growth. The National Institutes of Health recommended even high levels in a report issued in 1994. NIH said children 1 through 5 need 800 mg; 6through 10 should get 800-1,200 mg, and those 11 through 18 need 1,200–1,500 mg per day.

A cup of milk or calcium-fortified orange juice has 300 mg of calcium, as does 1.5 oz of cheddar cheese. A cup of yogurt can have as many as 415 mg. A half-cup of white beans has 115 mg of calcium.

According to the Institute of Medicine, most preteens and adolescents are only getting 700–1,000 mg (boys are at the higher end of the range). The same is true of vitamin D.

“Kids’ average intake does not match the optimum, although boys do better than girls,” Dr Sylvester said.

Vitamin D helps prevent calcium loss from bones. It is sometimes called “the sunshine vitamin” because it is made in skin that is exposed to sunlight. Persons who are outside in the sunlight every day for 15 to 30 minutes generally get all the vitamin D that is necessary. However, in northern locations in winter, the sunlight may be too weak to make vitamin D in the skin. Vitamin D may also be obtained from foods and beverages or from multivitamin preparations. Most milk is fortified with vitamin D.

The best way to get enough calcium is to get it though a good diet. Calcium supplements are available, but there can be side effects and interaction with other medications, so their use in children should be monitored by a physician. An excellent website on calcium supplements is available at www.nlm.nih.gov/medlineplus/druginfo/uspdi/202108.html, according to Dr Sylvester.

“The best treatment is diet, exercise, lifestyle changes, and minimizing the impact of disease when it happens,” he said.