An Overview of Juvenile Osteoporosis

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Juvenile osteoporosis is a rare form of osteoporosis that typically begins just before the onset of puberty. The average age at onset is seven years old, with a range between one to 13 years old. Osteoporosis is a progressive bone disease where bone density is lost or there is insufficient bone formation. The result is weakened bones and susceptibility to fracture. 

Osteoporosis can be a serious problem when it affects young people because this is a time when they are building most of their bone mass. Losing bone mass during this crucial time can put a child at risk for serious complications, including abnormal bone development.

Symptoms

The first sign that a child has osteoporosis is pain in the low back, hips, and/or feet.  The child may also have difficulty walking or walk with a limp. Fractures of the lower extremities are a common complication, especially of the knee or ankle. 

Juvenile osteoporosis may also cause physical deformities, including:

Causes

Osteoporosis is more common in older adults—especially menopausal and post-menopausal women—but it can also affect children. Osteoporosis in children is rare, and it is often caused by an underlying medical condition. There are two types of juvenile osteoporosis: secondary and idiopathic.

Secondary osteoporosis is more common than idiopathic juvenile osteoporosis, but the exact prevalence is unknown. Secondary juvenile osteoporosis is caused by another medical condition. A diagnosis of idiopathic juvenile osteoporosis is made when the cause of the disease is not identified. 

Secondary Juvenile Osteoporosis

Some of the diseases that may lead to secondary juvenile osteoporosis in a child include:

Juvenile arthritis (JA): Different types of JA involve disease processes that contribute to the development of osteoporosis. For example, children with juvenile idiopathic arthritis have bone mass than is lower than expected, especially in the joints that are affected by arthritis. And studies show that drugs used to treat JA, such as prednisone, can negatively affect bone mass. Further, some behaviors related to JA, such as avoiding physical activity due to pain, can also reduce bone strength and bone mass.

Type 1 diabetes: Type 1 diabetes, a type of diabetes where the body produces too little or no insulin, usually begins during childhood or the young adult years. Type 1 diabetes is associated with poor bone quality and an increased risk for fractures. 

Cystic fibrosis (CF): CF is a progressive, genetic condition that causes recurrent and ongoing lung infections, and over time, eventually limits the ability to breathe. Lung disease can slow down puberty and hinder a child’s bone growth and lead to weaker bones.

Malabsorption diseases: Malabsorption due to bowel diseases (e.g. Crohn’s disease, celiac disease, etc.) reduces the absorption of nutrients from the intestines, including calcium and vitamin D. This can increase bone loss and increase the risk of fractures.

Female athlete triad syndrome: This condition is defined as a combination of a lack of dietary nutrition due to eating habits, missed periods, and osteoporosis.

Medications: Treatments such as chemotherapy drugs, anti-convulsant medications, and corticosteroid drugs can interfere with bone formation. If your child has cancer, seizures, or arthritis, you may want to talk to their healthcare provider about how often they need their bone density checked. 

Lifestyle: Sometimes, juvenile osteoporosis is related to certain behaviors, such as prolonged immobility or inactivity. Inadequate nutrition—especially lack of vitamin D and calcium—may also contribute to juvenile osteoporosis. 

Idiopathic Juvenile Osteoporosis

Idiopathic juvenile osteoporosis is less common than secondary.  It seems to affect more boys than girls and it starts before puberty, with an average onset of 7 years of age.  

While there are no known causes for idiopathic juvenile osteoporosis, researchers have confirmed that genetics plays a role. For example, mutations of certain regulatory proteins have been linked to early-onset osteoporosis with axial (spinal) and appendicular (limbs) fractures during childhood.

With this type of osteoporosis, your child’s bone density may recover during puberty. However, bone density will still not be normal when bone mass peaks later into adulthood.

Diagnosis

A diagnosis of juvenile osteoporosis can be a hard diagnosis to make. Bone density scans are the most accurate way to identify lowered bone mass. These scans look at bone mineral content and skeletal changes, including bone loss. These tests, however, are not always accurate and need to be looked at carefully in order to make an osteoporosis diagnosis.

Your child’s healthcare provider will rely on signs and symptoms that indicate your child may have fragile bones. This includes pain in the lower back, hips, and feet, problems walking, knee and ankle pain, and bone fractures.

A diagnosis is usually made when a child has a broken bone. X-rays can show low bone density, fractures, or a collapsed or misshaped vertebra (bones of the spinal column). Unfortunately, X-rays won't detect osteoporosis until there has been a significant bone mass loss.

Newer types of X-ray, including dual-energy X-ray absorptiometry (DXA), dual photon absorptiometry (DPA), and quantitative computed tomography (CAT scans), can help with an earlier and more accurate diagnosis of low bone mass.

Juvenile Osteoporosis vs. Osteogenesis Imperfecta

Osteogenesis imperfecta (OI) is a rare genetic disorder. Much like juvenile osteoporosis, it is known for causing weak bones that are susceptible to fracture. It is caused by problems with the quantity and quality of bone collagen.

Collagen is a hard, insoluble, and rubbery protein found in bones, muscles, skin, and tendons. Children who have OI will not achieve normal bone mass. This condition ranges from mild to severe, and it is inherited.

Features of OI include:

  • Bones that fracture easily
  • Bone pain
  • Loose or hypermobile joints (joints that have a higher range of mobility)
  • Low muscle strength
  • Small stature, especially in moderate to severe cases
  • Possible hearing loss
  • Eye problems
  • Possible brittle teeth, a condition called dentinogenesis imperfecta

The two main features of OI that make it distinguishable from juvenile osteoporosis are family history and eye problems. In some cases, distinguishing OI from juvenile osteoporosis may require genetic testing.

Treatment

Once your child has a diagnosis, your child’s healthcare provider will want to develop a specific treatment plan. Treatment is based on the severity of the disease and is usually aimed at protecting the spine and other bones from fracture.

Similar to their peers, children with secondary osteoporosis need a diet rich in vitamin D and calcium. They also should get as much physical activity as possible given within the limits of their health.

Treating the Source

Treatment mainly depends on the cause of osteoporosis symptoms. With secondary juvenile osteoporosis, your child’s healthcare provider will want to identify and treat the underlying cause. 

If an underlying medical condition is the source, this will include diagnosing and treating that disease. With medication-induced juvenile osteoporosis, it is best to treat the primary condition with the lowest effective medication dose or find an alternative and effective treatment.

Exercise

You should encourage your child to take part in regular exercise. Ask your family pediatrician for a referral to a physiotherapist or exercise physiologist. This person can help create an exercise program that promotes bone health, is safe, and reduces the risk for fractures.

Exercise and juvenile osteporosis.
 Catherine Song / Verywell

You will want your child to be active, but it is a good idea to avoid sports where your child could easily get injured, such as contact sports.

Calcium and Vitamin D

Since calcium is an important part of bone health, adding more calcium to your child’s diet can increase bone strength and reduce fracture risk. Good dietary sources of calcium include dairy (milk, yogurt, cheese, etc.) leafy green vegetables, and calcium-fortified foods. A dietitian can be a great source of information for increasing calcium in your child’s diet. 

You should also make sure your child is getting enough vitamin D because this vitamin increases the absorption of calcium and makes bones stronger. We get most of our vitamin D exposure from the sun, so make sure your child is exposed to sunlight daily. If you are concerned your child is not getting enough vitamin D, talk with their healthcare provider.

Medication

Your child may need medication to manage symptoms. This may include pain medications after a fracture or, if a child has severe osteoporosis, medications to encourage bone strength. These include fluoride, calcitonin, and bisphosphonates.

Your child's healthcare provider is in the best position to determine which medication options might be the best treatments. Your child’s practitioner may also prescribe calcium or vitamin D supplements if your child is not getting enough from diet or sunlight exposure.

Long-Term Problems

Untreated juvenile osteoporosis can lead to long-term problems. This is because children and young adults build up their peak bone bass before age 30. Building strong bones during childhood reduces the risk of osteoporosis later in life.

Without treatment, juvenile osteoporosis can affect bone strength and density, increasing the risk of fractures and malformed bones. That is why early diagnosis and treatment of juvenile osteoporosis are important.

A Word From Verywell

You can promote healthy bone habits in your children by encouraging proper nutrition and plenty of exercise. Eating for bone health means getting plenty of foods that are rich in calcium and vitamin D, including dairy, calcium-rich fruits, and leafy vegetables, nuts and seeds, and some types of oily fish (i.e. sardines and salmon). You should also try to limit children’s access to soft drinks and snacks that don’t provide calcium.

Help your kids find a variety of physical activities they can enjoy participating in and establish limits for sedentary activities, such as watching TV and playing video games.

Another good way to promote your children’s bone is health is by being a good role model. Drink milk with meals, snack on calcium-rich foods, and get plenty of exercise. Don’t smoke. You may not realize it, but your children are watching, and your habits—good and bad—have a strong influence on them now and into the future.

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6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. NIH Osteoporosis and Related Bone Diseases. What People With Diabetes Need To Know About Osteoporosis.

  3. Cystic Fibrosis Foundation. What Are the Causes of Bone Disease in CF? (n.d.)

  4. Saraff V and Högler W. Endocrinology and adolescence: Osteoporosis in children: diagnosis and management. Eur J Endocrinol. 2015 Dec;173(6):R185-97. doi:10.1530/EJE-14-0865

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