Osteoporosis in children

Osteoporosis in children is 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. Juvenile osteoporosis occurs between the ages of one and 13 years, with the average age of onset at seven years of age.

Osteoporosis means ‘porous bones’. Osteoporosis occurs when bones lose minerals such as calcium more quickly than the body can replace them. They become less dense, lose strength and break more 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. However, signs and symptoms of osteoporosis can include:

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

A range of causes

Juvenile osteoporosis is classified by the underlying cause. The four main causes include:

• Genetic disorders – certain medical conditions present at birth, such as osteogenesis imperfecta, may cause osteoporosis.
• 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.

Diagnosis

Diagnosis of juvenile osteoporosis may include:

• Physical examination
• Medical history
• Medical histories of family members to find out if a genetic disorder is the cause
• X-rays, including dual energy x-ray absorptiometry (DXA), a scan to test bone density
• Blood tests.

Idiopathic juvenile osteoporosis

Sometimes no underlying cause can be found. In these rare cases, the disease is called idiopathic juvenile osteoporosis. A child with this disease tends to have symptoms including pain and spinal deformities. Blood tests usually show that calcium and phosphorus levels are within the normal range. This diagnosis can only be made by excluding other causes of low bone density.

Generally, idiopathic juvenile osteoporosis tends to resolve by itself, and most children will experience a complete recovery of bone tissue. On the other hand, disability may extend into adulthood. The reason for this is unknown.

Long-term risks

Peak bone mass occurs during the teenage years. Without treatment, juvenile osteoporosis can affect bone integrity and increase the child’s risk of osteoporosis and osteoporotic fractures in later adult life. Females are at higher risk than males because of:

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

Girls with juvenile osteoporosis caused by osteogenesis imperfecta are most at risk. Diagnosis and treatment is very important.

Treatment

In most cases, juvenile osteoporosis can be treated. Treatment of any underlying medical condition is important, if it has not already been diagnosed and treated.
Treatment depends on the underlying cause but may include:

• 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 in the diet – including low-fat dairy products such as milk, cheese and yoghurt – and increasing the intake of broccoli and leafy green vegetables.
• Adequate vitamin D – we obtain most of our vitamin D from the sun, so it is important to expose the hands, face and arms to the sun for 6–8 minutes every day in the warmer months (avoiding the hottest period of the day between 10am–3pm), and about 30 minutes in the cooler months. For most people it is unlikely that adequate quantities of vitamin D will be obtained through diet alone.
• Taking calcium and vitamin D supplements if necessary – talk to your doctor.
• Protecting the child against fractures – for example, by avoiding contact sports.
• Avoiding caffeine (such as coffee, tea and soft drinks that contain caffeine).
• Medications – to help manage symptoms, such as pain-killing drugs, or ones such as bisphosphonates to encourage bone strength in the case of severe osteoporosis. Discuss medication options with your doctor.

Where to get help

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

Things to remember

• Juvenile osteoporosis is osteoporosis in children.
• The main causes of juvenile osteoporosis include osteogenesis imperfecta, certain medical conditions such as juvenile arthritis, 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.

You might also be interested in:

• Bones.
  
• Osteoporosis.
  
• Osteoporosis - prevention and treatment.
  

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Arthritis Victoria

Fact sheet currently being reviewed.
Last reviewed: January 2011

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Osteoporosis in children is called juvenile osteoporosis. It can be caused by certain medical conditions, genetic disorders, some drugs used to treat medical conditions or lifestyle factors such as poor diet and lack of exercise. In rare cases the condition has no cause and is known as idiopathic juvenile osteoporosis.

Content on this website is provided for education and information purposes only. Information about a therapy, service, product or treatment does not imply endorsement and is not intended to replace advice from your qualified health professional. Content has been prepared for Victorian residence and wider Australian audiences, and was accurate at the time of publication. Readers should note that over time currency and completeness of the information may change. All users are urged to always seek advice from a qualified health care professional for diagnosis and answers to their medical questions.

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