Prevention of Bone Loss in Children and Teenagers

Prevention of Bone Loss in Children and Teenagers

Childhood and teenage years are critical periods for developing a strong healthy skeleton, especially right before puberty between the ages of 8 and 12 years.

Exercise is vital for healthy bones in young people, especially girls.

Research shows that bone (strength and quality) can be significantly increased at this time and weight-bearing activities should be encouraged.

Bone is made up of a strong collagen meshwork, with calcium deposited within it to make it hard. At millions of different sites throughout the skeleton, bone destroying cells called osteoclasts break down old bone, and bone-building cells called osteoblasts make up new bone. In children with osteoporosis, more bone is lost compared to the amount of new bone formed.

In children, cells that make new bone work fast, and as a result, the skeleton structure increases in density and strength, especially when weight-bearing and strengthening exercise is included.

Our genes mainly determine the potential height and strength of our skeleton, but lifestyle factors can influence the amount of bone you build (peak bone mass).

A well-balanced diet, containing calcium, Vitamin D, adequate proteins, and calories, as well as normal hormones, regular weight-bearing/strengthening exercise can help to make and maintain strong bones.

Peak bone strength is reached by the early ’20s and stabilises until the age of 35-40 when natural bone loss begins. If good peak bone strength is achieved in early childhood, the risk of osteoporosis in later life can be significantly reduced.

The best sources of calcium are dairy products such as milk, cheese, and yogurt. Calcium can also be found in other foods such as bread, green leafy vegetables, and baked beans. However, calcium is not as easily absorbed from these foods. Children need the daily recommended intake of calcium and vitamin D, to help form healthy bones and to help keep their bones strong and healthy.

Vitamin D is needed to help the body to absorb calcium. Although foods such as dairy products, margarine, and fish oils contain vitamin D, the main source of the vitamin is usually from sunlight on the skin. Approximately 15 minutes (this can be broken up into 3 sets of 5 minutes) of sunlight a day, during the summer months if there is adequate sunshine. Make sure to put sunblock on after this time, so the risk of skin cancer is not increased. Vitamin D from the sun is not advised if a person burns easily. Children under 1 year of age should not be exposed to direct sunlight, and we recommend young children should get their Vitamin D preferably from food or fortified milk, but if this is not feasible, then from a supplement.

Weight-bearing/strengthening exercise can significantly help bones to increase their strength, as this puts positive pressure on the bones, causing them to become stronger.

Impact loading exercise for those who do not have bone loss such as skipping, jumping, hopping, team sports, and running are the best types of exercise for bone health, especially in young children. Research shows that weight-bearing exercise, especially right before puberty can significantly improve bone density.

Swimming and cycling are great all-around exercises, but they have very little effect on the bone because the body is not supporting itself.

Bone health can be influenced in a negative way. A lifestyle involving over-exercising, under-exercising, excess alcohol, over-dieting, eating disorders, lack of the daily amounts of calcium, vitamin D, proteins, or smoking, are ways in which the skeleton can be damaged.

Over-dieting can severely affect a growing skeleton as this is a crucial time for bone development.  It can also disturb sex hormone levels, which will affect bone and fertility.

After puberty, teenage girls need adequate levels of the female sex hormone oestrogen for their bones to be protected. Excess dieting can decrease a person’s body weight to the degree that oestrogen is no longer produced. A sign of this problem is when periods become irregular or stop completely.

Teenagers who have had no periods for 3 months or more, are placing themselves at increased risk of developing osteopenia and/or osteoporosis at a very early age.

Osteopenia is the early stage of osteoporosis. There are three stages regarding osteopenia: mild, moderate, and marked. Research shows that most people fracture (break bones) in the moderate to marked Osteopenia range.

If periods do not start until after age 15 the skeleton can also suffer, so it is important to seek a GP or Gynaecologist’s help in identifying the cause/s of any late-onset of periods.

Over-exercising in girls can work in a similar way to over-dieting, as it may lead to a reduction in body fat and body weight.  This may result in irregular periods or periods stopping. Young women, who over-exercise especially those who also have an eating disorder, are at a significantly increased risk of osteoporosis unless action is taken to restore regular periods. We have 19-year-olds with crushed vertebrae (bones in the spine have collapsed causing a hump on their upper back), due to over-exercising and/or eating disorders. However, they can significantly improve their bone health once diagnosed, to prevent fractures or to prevent further fractures.

NOTE: The sooner a person gets help for their eating disorder or over excising, the better results they will have. Bone strength can be improved, and further fractures prevented, but if rounded shoulders or a hump has developed due to vertebral fractures (broken bones in the spine), they cannot be corrected.

Smoking damages the skeleton in addition to causing cancers. Smoking takes calcium from the bones and causes the body to lose the other essential vitamins and minerals it needs to grow.

Fizzy drinks containing phosphates are another problem with children, as acidic substances can leach calcium from the bones. Milk, especially those fortified with vitamin D, should be encouraged as well as water and healthy fruit juices.

The good news is that osteoporosis can be prevented and treated in most cases, but it is critical to act early. Building a strong skeleton during childhood and adolescence will help to protect against bone loss and osteoporosis in later life.

Establishing healthy eating and exercise habits in childhood, which should be continued throughout adulthood, is an important step to ensuring that our children, do not become the next generation of Osteoporosis sufferers.

Children are very prone to broken bones; however, most of these fractures are usually due to an injury rather than osteoporosis. If a child breaks a bone (a low trauma) from a trip and fall or has unexplained persistent back pain, a questionnaire should be filled in to see if they have any risk factors for osteoporosis. If they have no risk factors, healthy eating including adequate calories, calcium, vitamin D, proteins and weight-bearing exercise should be encouraged.