Kids and Osteoporosis

What is osteoporosis?

Osteoporosis is a loss of bone mass or density or the failure to develop sufficient bone mass which can lead to skeletal fractures in a variety of areas, including the spine, the wrists, and the hips. It is called the "silent disease" as the patient does not have any symptoms until a fracture occurs. Rickets and osteomalacia are different conditions caused by lack of Vitamin D which leads to brittle bones and pain. All of these conditions are affected by levels of and intake of both calcium and vitamin D. These two vitamins are closely intertwined in our bodies and levels of each are strictly regulated by certain endocrine organs in our bodies.

Our peak bone mass is reached somewhere between our teen years through our twenties and then can begin to fall after the age of thirty. Today's adolescents and teens are at higher risk due to several lifestyle factors that will be reviewed.

Preexisting Conditions

Some children may have medical conditions which could lead to osteoporosis, such as juvenile rheumatoid arthritis. This condition, due to its effects on the immune system, on the bones adjacent to affected joints, and partially due to medications used for treatment, can lead to osteoporosis as a secondary problem. Epilepsy is controlled by many medications that can have the long term effect of causing osteoporosis. Other conditions that can lead to osteoporosis are hyperthyroidism, hyperparathyroidism, kidney disease, and lactose intolerance or other malabsorption syndromes

Diet

In general milk consumption in our country is down. The decrease in milk consumption is partially due to the overwhelming abundance and availability of other drinks, such as soda, juices, and "energy" drinks that are very attractive to young people. As a result, kids are getting less calcium from milk and milk has been fortified with Vitamin D for many decades. We have seen an increase in the prevalence of lactose intolerance in many groups which would automatically lead to eliminating milk and milk products out of the diet. These patients do not possess the enzyme to break down the lactose sugar in milk. Lactose intolerance is more prevalent in adults but is also seen in children. Vegetarians and vegans do not drink milk products by choice due to beliefs that animal products are generally unhealthy.

There are also beliefs in the vegan community that drinking milk can actually lead to osteoporosis. As an alternative, some orange juice products have added calcium and Vitamin D as well as some cereals and soy milk although dairy milk provides much more per serving. There are other milk product alternatives on the market that have added calcium such as almond milk, rice milk, and soy milk. These typically provide less of the recommended daily allowance of calcium and vitamin D but can still be healthy alternatives. Cow's milk also provides more protein that milk alternatives.

Obesity

Obesity is a predominantly "first world" problem. Diets are often based on quick foods, carbohydrate-laden foods, and contain minimal amounts of protein, fish, fruit, and vegetables. There are also factors such as a general trend towards less outdoor activity, less physical education classes in school and the exponential popularity of computers, tablets, phone, video games, and social media. These are indoor activities and hugely popular with adolescents and teens which has led to a sharp decline in outdoor play time.

Obesity can contribute to osteoporosis directly by reducing the positive impact of lean muscle mass on bones and by the lack of physical impact on bones through running and jumping which increases bone mass and density. Obesity can also contribute indirectly as overweight children will likely be spending less time playing outside or playing outdoor sports. This also means they are absorbing minimal amounts of Vitamin D which is absorbed by being in the sunlight. We are unable to absorb Vitamin D from the sunshine filtered through windows.

Vitamin D

Vitamin D is obtained primarily through exposure to sunlight and a chemical reaction that takes place in the skin to convert the vitamin D to a biologically active form. Very few foods contain vitamin D and many of the foods that do are typically not foods that adolescents and teens would eat. Vitamin D rich foods include salmon, tuna, beef liver, and a small amount in eggs. Much of the vitamin D we get is from fortified foods and milk. Since there is a minimal amount of vitamin D in breast milk, exclusively breast-fed infants can become deficient. These children need Vitamin D supplements.

Occasionally we can see vitamin D deficiencies in certain cultural or religious groups that wear more concealing clothing including head coverings, that discourage outdoor activities or sports, and that encourage more indoor, scholarly activities. This can be observed in some ultra-orthodox Jewish populations and Muslim populations.

Bad Habits

Smoking and drinking alcohol can lead to osteoporosis due to the negative impact of these habits directly on bones and circulation as well as the sedentary lifestyle often led by adolescents, teenagers, or young adults that display these more addictive behaviors.

The following tables are guides to recommended daily calcium intake for different age groups and also common foods and their calcium content:

A chart depicts recommended calcium intake by age.

A chart depicting foods that are a good source of calcium.