Osteoporosis Strikes Before Middle Age

Osteoporosis affects both children and adolescents

/ Author:  / Reviewed by: Joseph V. Madia, MD

Is your child accident prone? Do trips and falls that another kid would walk away from, cause hospital trips and multiple broken bones? If so, your child might have osteoporosis.

Osteoporosis is thought of as a condition that develops with age, as bones weaken and people become frail. Low bone density is relatively common among women and men who are in the middle of their lives.

But a child who is prone to fracturing bones might have a form of juvenile osteoporosis, a much rarer condition.

Osteoporosis, whether found in adults or children, is a condition characterized by low bone density and an increased risk of bone fractures. It occurs when the body does not build enough bone to compensate for bone that is being lost.

It's called a silent disease, because many people may not know they have it until they have a fracture. In adults, osteoporosis can be caught before an injury through bone density screening.

But this is not recommended for children, who usually are in the process of rapidly growing and accumulating bone mass.

Children may only have their bones tested if they've suffered from multiple broken bones, or if they've broken their hip or spine – an unusual break for a child. This shows that they have a fragile skeleton.

There could be any number of reasons for the child's condition, and their diagnosis could come under the heading of three conditions.

Secondary Osteoporosis

Secondary osteoporosis has its roots in a primary condition. That means that the child has another disease, and may already be receiving treatment for it.

In some cases, the disease itself may cause secondary osteoporosis. In other cases, the treatment for the disease may result in the secondary condition.

Diseases that may result in secondary osteoporosis include:

  • Juvenile rheumatoid arthritis
  • Diabetes
  • Osteogenesis imperfecta
  • Hyperthyroidism
  • Hyperparathyroidism
  • Cushing's syndrome
  • Malabsorption syndromes
  • Anorexia nervosa
  • Cystic fibrosis
  • Kidney disease

To use juvenile rheumatoid arthritis as an example, children with this condition have been found to have lower than expected bone mass, which results in osteoporosis.

Medications, such as steroids, can be responsible for osteoporosis in children. For example, steroids often used to treat arthritis can slow bone growth in children.

Anticonvulsants, for conditions such as epilepsy, and chemotherapy can have the same effect.

There's also a behavioral component: A child that avoids physical activity due to their disease doesn't have the opportunity to grow bone like a normal, active child.

The typical approach to treating secondary osteoporosis is to treat the underlying condition. If the medication is responsible, doctors may try to use the lowest effective dose to minimize the side effects.

Idiopathic Juvenile Osteoporosis

Idiopathic juvenile osteoporosis, commonly known as juvenile osteoporosis, is diagnosed only when secondary osteoporosis has been ruled out. There is no known cause of this condition, and it's rare.

Children as young as one and as old as thirteen can have juvenile osteoporosis. Its average onset is seven years old.

The good news about this condition is that it goes away once the child is a teenager, and they experience a complete recovery of bone.

But before it disappears, the child typically has pain in his lower back, hips, and feet. He might have difficulty walking. Fractures are common, and physical malformations are possible.

Treatment options include physical therapy, avoiding weight-bearing activities, and using crutches. In some cases, medications may be prescribed.

Osteogenesis Imperfecta

Osteogenesis imperfecta (OI) is a genetic condition that affects the body's ability to make strong bones. Often, people with OI will have brittle teeth as well.

There's no cure for this condition. Most treatments attempt to control the symptoms, and surgeries are common. Doctors also encourage patients to exercise as much as possible to promote muscle and bone strength, which can prevent fractures.