Juvenile osteoporosis

What is osteoporosis?

Osteoporosis is a progressive condition in which bone density is lost, or there is insufficient bone formation, thereby weakening the bones and making them more susceptible to fractures. Although much more common in older adults, especially women in menopause and after, osteoporosis can also occur during childhood. The average age of onset is between 8 and 14 years, but it can occur in younger children during growth spurts. Most often, osteoporosis during childhood is caused by an underlying medical condition (the disease is then called secondary osteoporosis) or a genetic disorder (such as osteogenesis imperfecta). However, sometimes, no cause can be found and the disease is categorized as a very rare form of osteoporosis, called idiopathic juvenile osteoporosis (IJO).

What causes juvenile osteoporosis?

Researchers believe that the hormone estrogen plays a significant role in the progression of osteoporosis in older women. In children, the following causes may be attributed to the different forms of osteoporosis:

• Secondary osteoporosis disorders (caused by an underlying medical condition).
  • Juvenile arthritis
  • Diabetes mellitus
  • Osteogenesis imperfecta (OI), a genetic disorder that is also characterized by easily fractured bones. OI is usually caused by imperfectly formed bone collagen due to a genetic defect. OI is different from idiopathic juvenile osteoporosis (IJO) in the fact that a family history of OI is usually present and a person with OI often has short stature, dental problems, blue sclera (eye whites), and hearing loss.
  • Homocystinuria
  • Hyperthyroidism
  • Hyperparathyroidism
  • Cushing's syndrome
  • Malabsorption syndromes
  • Anorexia nervosa
  • Kidney disease
• Medications, including the following:
  • Anti-convulsants (for seizures)
  • Corticosteroids
  • Immunosuppressive medications
• Lifestyle
  • Excessive inactivity/immobility
  • Dietary calcium and vitamin D deficiency
  • Excessive exercising leading to amenorrhea

What are the symptoms of juvenile osteoporosis?

Persons with osteoporosis may not develop any symptoms and the disease, therefore, is often called silent. However, children with the rare idiopathic juvenile osteoporosis (IJO) may develop lower back, hip, and foot pain. In addition, IJO is sometimes coupled with physical deformities, including abnormal curvature of the thoracic spine (kyphosis), sunken chest, or a limp. The symptoms of juvenile osteoporosis may resemble other bone disorders or medical problems. Always consult your child's physician for a diagnosis.

How is juvenile osteoporosis diagnosed?

Diagnosis of juvenile osteoporosis is often not made until the child has a broken bone. In addition to a complete medical history and physical examination, diagnostic procedures for juvenile osteoporosis may include:

• Family medical history
• Skeletal x-rays - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• Bone density test - a diagnostic procedure to determine bone mineral content and skeletal changes, such as bone loss.
• Blood tests (to measure serum calcium and potassium levels)

Treatment for juvenile osteoporosis:

Specific treatment for juvenile osteoporosis will be determined by your child's physician based on:

• Your child's age, overall health, and medical history
• Extent of the disease
• Your child's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Your opinion or preference

The effects of this disease can best be managed with early diagnosis and treatment. In secondary osteoporosis, treatment may include treating the underlying cause of the disease. Some of the methods used to treat osteoporosis are also the methods used to help prevent it from ever developing. Treatment may include:

• Help your child to maintain an appropriate body weight
• Increase walking and other weight-bearing exercises
• Minimize the amount of caffeine in your child's diet
• Help your child maintain an adequate intake of calcium through diet and supplements (vitamin D is also necessary because it facilitates the absorption of calcium)

Consult your child's physician regarding a medication regimen.

In the case of idiopathic juvenile osteoporosis, treatment may not be necessary. IJO often resolves itself spontaneously. Nevertheless, managing the bone loss is important during a child's important bone-building years. Treatment for IJO may include:

• Protection of spine and other bones from fractures
• Physical therapy
• Medications (to manage the symptoms)