Osteoporosis in children

Osteoporosis in children is sometimes called juvenile osteoporosis. This rare condition is usually caused by an underlying medical condition, some drugs used to treat a medical condition, or lifestyle factors such as poor diet and lack of exercise.

Less commonly, osteoporosis will occur for an unknown reason. This is known as idiopathic juvenile osteoporosis. In most cases, the onset occurs between the ages of eight and 14 years.

Osteoporosis means ‘bones with holes’. The bones lose calcium, become less dense and tend to break easily. While osteoporosis is more common in older people, especially in postmenopausal women, the condition may occur at any age.

Symptoms
Juvenile osteoporosis may not cause any obvious problems to the child. Signs and symptoms of osteoporosis may include:

• Pain in the lower back, hips or feet
• Spinal deformities such as sideways curving (scoliosis) or hunching in the upper back (kyphosis)
• Chronic limp.

• Genetic disorders – certain medical conditions present at birth, such as osteogenesis imperfecta, may cause osteoporosis. Osteogenesis imperfecta is caused by a malfunctioning gene that interferes with the development of bone collagen, the component that gives bone its strength. Usually, a child with this condition has other family members with the condition and has symptoms including short stature and hearing problems.
• Other medical conditions – such as juvenile arthritis, kidney disease, hyperthyroidism, Cushing’s syndrome, inflammatory bowel disease, cystic fibrosis, thalassaemia, some types of cancer or diabetes.
• Medications – such as some types of cancer treatments, anticonvulsant medications used to manage epilepsy or corticosteroids. Corticosteroids are used to treat a wide range of diseases including arthritis and asthma.
• Lifestyle – eating disorders, such as anorexia nervosa, or excessive exercise that leads to disruption of the menstrual cycle. Children who are bedridden are at increased risk of juvenile osteoporosis because weight-bearing activities encourage bone density.

• Smaller skeleton and lower peak bone mass
• Menopause and the associated drop in the female hormone oestrogen, which is a known risk factor in the development of osteoporosis.

• Physical examination
• Medical history
• The medical histories of family members to find out if a genetic disorder is the cause
• X-rays
• Blood tests
• Bone density test.

• Changing medication if the underlying medical condition is already being treated. The doctor may lower the dose of some drugs (such as corticosteroids) or prescribe a different medication.
• Encouraging the child to take part in an appropriate exercise program of weight-bearing activities prescribed by a health professional (like a physiotherapist) to encourage increased bone density. Review by a physiotherapist is important to make sure the activities help to promote bone growth, are safe and do not cause a fracture.
• Increasing calcium and vitamin D in the diet – including low-fat dairy products such as milk, cheese and yoghurt – and increasing the intake of broccoli and leafy green vegetables.
• Taking calcium and vitamin D supplements – seek doctor’s advice.
• Protecting the child against fractures – for example, by avoiding contact sports.
• Avoiding caffeine (such as coffee, tea and soft drinks that contain caffeine).
• Offering medications to help manage symptoms, such as pain-killing drugs.
• Prescribing drugs such as bisphosphonates to encourage bone strength in the case of severe osteoporosis. Short-term side effects of this treatment may include fever and inflammation of the iris (iritis).

• Your doctor
• Paediatrician
• Arthritis Victoria incorporating Osteoporosis Victoria Tel. (03) 8531 8000 or 1800 242 141
• Osteoporosis Australia Tel. (02) 9518 8140

• Juvenile osteoporosis is osteoporosis in children.
• The main causes of juvenile osteoporosis include osteogenesis imperfecta, certain medical conditions, some medications and lifestyle factors including poor diet.
• Treatment depends on the underlying cause but may include dietary adjustments, a supervised exercise program and treatment for any underlying medical condition.

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