Mention bone density and most people imagine an older woman, stooped and fragile. But osteoporosis is not just an ‘old ladies’’ disease. Children, too, can be afflicted with this condition, and for a number of reasons, may be prone to the bone fractures that result from osteoporosis and its milder cousin, osteopenia.
“Typically, when parents think about their children’s health, they don’t think about their bones,” says Dr. Patricia Poitevien, director of pediatrics at the NYU Hospital for Joint Diseases in Manhattan. “But parents and pediatricians alike underestimate how often osteoporosis afflicts children. We believe it is a greatly under-diagnosed condition.”
Dr. Poitevien directs the Initiative for Pediatric Bone Health, an outpatient clinic affiliated with the Center for Children at the Hospital for Joint Diseases. The clinic, open twice a week, treats children with a range of low bone density disorders.
According to the National Institutes of Health, the primary disorders that can affect peak bone mass in children are juvenile arthritis, diabetes, hyperthyroidism, hyperparathyroidism, Cushing’s syndrome, malabsorption syndromes, anorexia nervosa, kidney disease, and liver disease. Other factors include smoking, alcohol abuse, prolonged inactivity, and inadequate nutrition. In addition, situations that can result in pediatric osteopenia and osteoporosis include the extended use of anti-convulsant medications (for epilepsy), steroids (for rheumatoid arthritis and asthma), and immunosuppressive agents (for cancer). Dr. Poitevien notes that children who are wheelchair-bound are also at risk due to prolonged immobility; gender, she says, is not a risk factor.
Osteoporosis in some young patients cannot be explained, Dr. Poitevien adds. This is known as idiopathic juvenile osteoporosis. “We do a full work up on them and we come up with nothing,” she says.
Severe fractures, particularly of the hip and spine, pose the greatest short-term danger for children with poor bone health. “In the long run, we’re concerned about osteoporosis and scoliosis as well,” Dr. Poitevien says.
Poor bone health generally presents itself in pre-adolescence and adolescence. Warning signs include multiple fractures, as well as complaints of constant aching in joints and bones. Patients are often referred to the Initiative for Pediatric Bone Health clinic when, after four or five fractures, their orthopedic surgeon begins to consider other possible causes. The majority are children with osteogenesis imperfecta, a genetic disease that causes the bones to break easily with little or no apparent cause. “We treat a wide array of these patients,” Dr. Poitevien says. “Some have had only one fracture; others have already had 20 or 30.”
The clinic also treats patients who have osteopenia and osteoporosis for reasons other than osteogenesis imperfecta and idiopathic juvenile osteoporosis. “We see a large spectrum of patients, from parents who are just questioning their children’s bone health, to those who know there is a problem,” Dr. Poitevien says. “Services range from simple counseling to full-out treatment.”
Although most osteopathic conditions cannot be cured, a combination of nutrition guidance, exercise plans and, in some cases, medications can manage the symptoms and improve quality of life for patients. In the most severe cases, medication is administered via IV during three-day hospital stays every three months for a period of two years. “After two years, patients take what we call a ‘drug holiday’,” Dr. Poitevien explains. “We monitor their bone density, and if it begins to drop, we reinstate treatment.”
Whether a child has low bone density or not, a diet with an adequate amount of calcium and vitamin D is crucial for bone health. “The exact amount depends on age and weight, but children should eat between three and five servings of dairy a day,” Dr. Poitevien advises. “We recommend low-fat dairy because obesity is also a big problem in pediatric patients.”
Children who are not at risk for osteoporosis or osteopenia today are not necessarily off the hook for the future. The Surgeon General’s November 2004 report on bone health indicated that 10 million Americans over the age of 50 have osteoporosis, and that by the year 2020, one out of every two Americans — both male and female — will develop or be at risk for developing the disease. The bone mass attained in childhood and adolescence is an important determinant of lifelong bone health. Proper habits of diet and exercise formed in kids today can prevent poor bone health tomorrow.
For more information on the Initiative for Pediatric Bone Health, call (212) 598-6412 or visit www.nyuhjdcenterforchildren.org.
Resources: • National Institutes of Health’s Osteoporosis and Related Bone Diseases National Resource Center, www.osteo.org • National Osteoporosis Foundation, www.nof.org • The Surgeon General’s November 2004 report on bone health can be found at www.surgeongeneral.gov/library/bonehealth/docs/Osteo10sep04.pdf