Although doctors usually diagnose osteoporosis in older adults, this condition can also affect children. Osteoporosis weakens the bones and increases the risk of fractures. In children, it can hamper growth and cause deformity and pain.
Osteoporosis is a bone disease that occurs when there is insufficient bone formation or too much bone density loss. These changes affect the strength and structure of the bone, making it weak and susceptible to fractures.
The condition is more common in older adults, affecting about
Although osteoporosis is rare in younger people, it can sometimes affect children and adolescents.
This article looks at osteoporosis in children in more detail, including its causes and symptoms, as well as the associated long-term complications.
Osteoporosis in children, or juvenile osteoporosis, is a rare bone disorder characterized by thinning bones in childhood.
The International Society for Clinical Densitometry defines it as the presence of a vertebral compression fracture in the absence of local disease or trauma. However, doctors may also diagnose osteoporosis in a child who has had two or more long bone fractures by the age of 10 years or three or more long bone fractures by the age of 19 years.
This condition may cause significant complications because it occurs during the years when a child gains approximately 90% of their total bone mass.
Osteoporosis in children commonly occurs as a feature of other conditions, when doctors will refer to it as secondary osteoporosis. Idiopathic osteoporosis, which is a primary condition with no known cause, is rare.
A range of underlying conditions can lead to osteoporosis in children, including:
- juvenile rheumatoid arthritis and other inflammatory conditions
- Cushing’s syndrome
- malabsorption syndromes
- anorexia nervosa
- nutritional problems
- kidney disease
- cystic fibrosis
- sickle cell anemia
- Turner syndrome
Osteoporosis may also develop as a result of certain medications, such as:
- seizure medications
- immunosuppressive agents
- anticancer medicines
- corticosteroids for asthma and rheumatoid arthritis
Engaging in limited physical activity and eating a nonnutritious diet can contribute to osteoporosis in children.
Primary osteoporosis in children is a type of osteoporosis resulting from an intrinsic skeletal defect, which may have an unknown cause or be genetic.
Osteogenesis imperfecta is the most common form of primary osteoporosis, affecting 1 in every 10,000–20,000 people worldwide. It is a genetic disorder in which genetic mutations cause a lack of collagen or abnormal collagen. These changes lead to abnormally formed bones or soft bones that are prone to breaking.
In some cases, doctors cannot find the cause of osteoporosis in the child. This condition is rare and called idiopathic juvenile osteoporosis (IJO). It typically develops in previously healthy children just before they reach puberty, but it can occur between the ages of 1 and 13 years.
Osteoporosis in children can present in different ways.
Some children have recurrent long bone fractures that can result from low impact trauma, such as tripping over a curb. Others may experience vertebral compression fractures, which can lead to loss of height, spinal deformity, and back pain.
Sometimes, vertebral compression fractures do not cause symptoms, and a doctor only identifies them when they carry out an X-ray.
Children with IJO often present with:
- lower back, hip, and ankle pain
- limping or difficulty walking
- hunching of the back, known as kyphosis
- a sunken chest
- loss of height
A child who does not receive treatment for their osteoporosis may have weaker bones and an increased risk of frequent fractures and impaired growth.
Although the symptoms of IJO are usually reversible, some do not improve, and they lead to permanent disability. These symptoms include a collapsed rib cage and curvature of the upper spine, known as kyphoscoliosis.
Diagnosing osteoporosis in childhood is complex. Bone density scans are the most reliable way to detect low bone density at an early stage, but careful interpretation is necessary to arrive at a precise diagnosis.
However, doctors do not request a bone scan unless they suspect the child to have osteoporosis. As a result, they often do not diagnose juvenile osteoporosis until a child has broken a bone.
When this occurs, the doctor will review the child’s medical and family history, including their medications. They will also conduct a physical exam and order several tests. These may include:
- X-rays: Doctors use this imaging technique to look for fractures.
- Dual-energy X-ray absorptiometry (DEXA) scan: A DEXA scan measures bone mass and density.
- Blood and urine tests: These tests check the levels of calcium, magnesium, phosphorus, and parathyroid hormone in the body.
The goals of treatment for childhood osteoporosis include:
- improving bone mass
- preventing pain, fractures, and deformities
- improving independence and mobility
There is no established medical or surgical treatment for childhood osteoporosis. The treatment options will depend on:
- the underlying cause
- the child’s age
- the child’s tolerance for treatment
- the severity of the disease
IJO usually resolves on its own and may not require treatment. However, it is still essential to protect the child from fractures and manage bone loss during their bone-building years. The treatment options may include:
- physical therapy
- splints to protect the spine and body from fractures
Secondary osteoporosis treatment
In children with secondary osteoporosis, the doctors will focus on treating the underlying condition. If necessary, they will review and change any medications that may be affecting the child’s bones.
They may also recommend:
- increasing physical activity in the form of regular exercise, walking, or weight-bearing activities
- eating an adequate, well-balanced diet
- maintaining a moderate weight
- reducing caffeine in the diet
- taking pain medications as necessary
- using splints
Doctors will also provide calcium and vitamin D supplementation, as insufficiencies may affect the child’s response to bisphosphonates, which are drugs that help prevent or slow down bone thinning.
The Food and Drug Administration (FDA) approved bisphosphonates for the treatment of osteoporosis in adults to help strengthen the bones. Doctors sometimes give these to children off-label.
Osteoporosis in children often responds to treatment, including nutrient supplementation and regular physical activity. Most children with IJO recover entirely.
Although growth may be impaired while the disease is active, expected growth catches up afterward. However, deformities may persist and cause permanent disability in some children.
Childhood osteoporosis is a rare but serious condition that may cause repeated fractures, pain, and disability. It can occur spontaneously or due to other medical conditions.
Doctors typically diagnose osteoporosis in a child after they experience their first fracture. Early diagnosis is essential to help protect the child’s bones from fracture.