Juvenile Osteoporosis

Juvenile Osteoporosis

Osteoporosis literally means “porous bone.” It is a disease characterized by too little bone formation or excessive bone loss or a combination of both. People with osteoporosis have an increased risk of fractures. It is most common in older people, especially older women.

Osteoporosis is rare in children and adolescents. When it does occur, it is usually caused by an underlying medical disorder or by medications used to treat the disorder. This is called secondary osteoporosis. Sometimes, however, there is no identifiable cause of osteoporosis in a child. This is known as idiopathic osteoporosis.

No matter what causes it, juvenile osteoporosis can be a significant problem because it occurs during the child’s prime bone-building years. From birth through young adulthood, children steadily accumulate bone mass, which peaks sometime before age 30. The greater their peak bone mass, the lower their risk for osteoporosis later in life. After their mid-30s, bone mass typically begins to decline – very slowly at first but increasing in their 50s and 60s. Both heredity and lifestyle choices – especially the amount of calcium in the diet and the level of physical activity – influence the development of peak bone mass and the rate at which bone is lost later in life.

Secondary Osteoporosis

Secondary osteoporosis, which can affect both adults and children, results from another primary disorder or therapy. Some examples are included in the box below.

As the primary condition, juvenile rheumatoid arthritis provides a good illustration of the possible causes of secondary osteoporosis. In some cases, the disease process itself can cause osteoporosis. For example, some studies have found that children with juvenile rheumatoid arthritis have bone mass that is lower than expected, especially near the joints affected by arthritis. In other cases, medication used to treat the primary disorder may reduce bone mass. For example, drugs such as prednisone, used to treat severe cases of juvenile rheumatoid arthritis, negatively affect bone mass. Finally, some behaviors associated with the primary disorder may lead to bone loss or a reduction in bone formation. For example, a child with juvenile rheumatoid arthritis may avoid physical activity, which is necessary for building and maintaining bone mass, because it may aggravate his or her condition or cause pain.

The best course of action when a child has secondary osteoporosis is to identify and treat the underlying disorder. In the case of medication-induced juvenile osteoporosis, it is best to treat the primary disorder with the lowest effective dose of the osteoporosis-inducing medication. If an alternative medication is available and effective, the child’s doctor may also consider prescribing it. Like all children, those with secondary osteoporosis also need a diet rich in calcium and vitamin D, and as much physical activity as possible given the limitations of the primary disorder.