Prevention of Osteoporosis in
(i) childhood & adolcence, (ii) Adults

Dr.Vinaya Kunjir.

Osteoporosis is a bone disease that occurs when the body looses too much bone, makes too little bone or both. As a result, bones become weak and may break from a minor fall or trauma. Osteoporosis means porous bone. When seen under microscope, healthy bone looks like a honey comb. When osteoporosis occurs, the holes and spaces in the honey comb become much larger than healthy bones. Osteoporotic bones lose density and mass. They weaken and are likely to break easily.

Facts about bone health in children:

• Prevention of Osteoporosis begins in childhood.
• Childhood and Adolcence or young adulthood are the bone building years in human life.
• As children grow, their bone mass increases until it reaches its peak bone mass (PBM).
• PBM is the greatest amount of bone an individual can attain.
• PBM is reached in late teen and early 20's.
• Children and adolescents who have higher PBM, have reduced risk of osteoporosis later in life.
• There is a continued increase in bone density and bone size and mass during the childhood years with rapid increase in bone mass during puberty.
• If there is disturbance in their process there will be a resultant decrease in PBM and the fracture risk will be increased in later life.

Fractures that influence the childhood bone development and PBM are.

1.Nutritional - Calcium supplementation increases the bone density in prepubertal children. Hence growing children need daily intake of calcium and Vitamin D. Dietary calcium intake is preferable as it is easily absorbed from the intestine.

2.Hormonal factors - hormones influence the bone density. During puberty, children with deficient sex steroid hormones have decreased bone mass. Girls who start menses early have increased bone mass.

3.Genetics - 80% of peak bone mass is attributed to genetics. Family history of osteoporosis is an important risk factor for osteoporosis.

4.Environmental factors - Alcohol and tobacco are important risk factors for development of osteoporosis.

Causes of Osteoporosis in childhood.

I) Primary causes -

1) Osteogenesis Imperfecta.

2) Ideopathic Juvenile Osteoporosis - Defective bone metabolism causes weak bones in childhood. Cause is unknown.

II) Secondary causes –

Osteoporosis in childhood can occur due to other causes.

1) Disease of digestive system - like liver disease or intestinal conditions.

2) Nutritional diseases - malabsorption syndrome and malnutrition.

3) Cancers - like leukemia, lymphoma.

4) Kidney diseases - kidney insufficiency.

5) Arthritis and connective tissue diseases - like JIA, Juvenile SLE and juvenile dermatomyositis.

6) Lung diseases - asthma.

7) Mental illness - depression, eating disorders.

8) Endocrine diseases – cushing’s syndrome, thyroid diseases, pituitary gland diseases, hypogonadism.

9) Drugs - like corticosteroids, methotrexate, anti seizure drugs.

Prevention of Osteoporosis in children.

What can I do to help my child and teenage kid to build and protect his bones.

• Provide a well balanced diet - parents are advised to give their children calcium rich foods like millet, yogurt, cheese, green leafy vegetables, figs.
• Make sure that the child gets right amount of Vitamin D. - children should be encouraged to play outdoors and ensure exposure to sunlight.
• Be sure your child is physically active. Children and teens need to be active every day. 60 minutes of moderate exercise daily is advised.
• No excessive dieting or over-exercising - it causes malnutrition leading to decreased bone mass.
• Stress the importance of healthy life-style - avoid smoking and underage alcohol consumption.
• Teach the importance of wearing helmet while riding two-wheeler vehicle, wearing seat belt while driving car and knee-pads during sports activity to protect the bones.

Prevention of Osteoporosis in Adults.

1) Regular Exercise - Adults in the age group 19 - 64 years should do atleast 2 hours 30 minutes of moderate intensity aerobic activity like - cycling, fast walking, swimming for atleast 2-3 days in a week.

Aerobic exercises are muscle strengthening exercises involving all major muscles - legs, hips, back, abdomen, chest, arms and shoulders.

Weight bearing exercises and resistance exercises are important for increasing bone density and prevent osteoporosis.

While exercising, wear footwear that provide adequate support to ankles and feet.

2) Healthy Eating and Vitamin D Supplements - Eating healthy balanced diet is recommended for everyone. Calcium is required for strong bones. Adults need 700 - 1000 mg calcium intake daily.

Calcium rich foods are -

(i)  Green leafy vegetables

(ii) Milk

(iii)Tofu, cheese

(iv) Yogurt

(v)  Dried fruits like figs

Vitamin D is important for strong bones and teeth as it helps your body to absorb calcium. All adults should consume 10 microgram of Vit D daily.

Dietary sources of Vit D are-

• Fish
• Red meat
• Egg yolk
• Liver
• Cereals - fortified foods

3) Get some Sun - daily expose to sunlight triggers Vitamin D production.

4) Stop smoking and drink less - quit smoking and limit alcohol intake as it increases the risk of osteoporosis.

Your genes are responsible for determining your height and the strength of your bones, but lifestyle factors like diet and exercises influence how healthy your bones are.