Low Bone Mass in Children, Part Two: Options

Lila de Tantillo Health Guide
  • Low Bone Mass in Children, Part One: Causes


    Low Bone Mass  in Children, Part Three: What Now?


    In adults, osteoporosis is generally defined as bone mineral density less than 2.5 standard deviations below what is expected for those of the same gender at peak bone mass. For children, however, a diagnosis of osteoporosis requires low bone mass plus a fragility fracture. The effects of such a condition can often involve a daunting array of factors that can leave the entire family feeling helpless.


    Statistically, about one of three children breaks a bone at some point. But when a child sustains a fracture - or multiple fractures, especially vertebral compression fractures - in a manner disproportionate to the trauma involved, there is cause for concern, especially if bone loss is evident from an X-ray.

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    "By the time you see loss of bone in an X-ray, you have lost 30 percent of bone mass," says Dr. Linda DiMeglio, a pediatric endocrinologist at Riley Hospital for Children in Indianapolis.


    At this point, a parent may want to consider the child undergo Dual Energy X-ray Absorptiometry, commonly known as a DXA scan, to better understand the condition. Since DXA is most commonly performed on older people, parents should ensure that the provider of the scan is equipped with software geared for their child's age. But if the scan is performed correctly and the results are not good, then parents should be prepared to be proactive.


    The first step in combating low bone mass in children is ensuring adequate levels of calcium, Vitamin D, and exercise. This is especially important if a nutritional deficiency is suspected as the cause of the problem. The National Osteoporosis Foundation recommends 1,300 mg of calcium daily for kids ages nine to 18 and 400-800 I.U. of Vitamin D - however, a physician may recommend even more for children with particular deficits. In addition, regular weight-bearing exercise is crucial to developing healthy bones.


    However, when the cause of the osteoporosis is not nutritional, supplementation by itself may not be enough. "Calcium or Vitamin D doesn't cut it," says Dr. Connie Weaver, director of the Foods and Nutrition Department at Purdue University.


    If the child's bone density is at a severely low level, or the child continues to fracture, families may wish to discuss with their physicians the possibility of medication. Since most osteoporosis drugs are FDA-approved for use by post-menopausal women, they would only be prescribed for children off-label. Taking this step requires a sensitive discussion and an individual decision made by the patient, parents and doctors after careful consideration of potential risks and benefits.


    Possible medications that are most often used to treat children in this situation include the bisphosphonates pamidromate (Aredia) and alendronate (Fosamax). This therapy is often conducted for several years. In addition, calcitonin is sometimes prescribed of-label in this circumstance, although its results are considered to be less impressive. Under no circumstance, however, should synthetic parathyroid hormone (Forteo) be prescribed to children. That medication was observed in rats to increase the risk of osteosarcoma, a concern considered especially relevant to the growing bones of youths.


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    Because of the limited research available on bone density problems in children, there is no medical consensus on the best way to proceed. For this reason, close consultation between the family and physician and regular monitoring of the condition is especially essential.

Published On: November 09, 2007