Juvenile osteoporosis is a condition of bone demineralization characterized by pain in the back and extremities, multiple fractures, difficulty walking, and evidence of osteoporosis. Symptoms typically develop just before puberty. Osteoporosis is rare in children and adolescents. When it does occur, it is usually caused by an underlying medical disorder or by medications used to treat the disorder. This is called secondary osteoporosis. Sometimes, however, there is no identifiable cause of osteoporosis in a child. This is known as idiopathic osteoporosis.

There is no established medical or surgical therapy for juvenile osteoporosis. In some cases, treatment is not necessary, as the condition resolves spontaneously. Early diagnosis may allow for preventive steps, including physical therapy, avoidance of weight-bearing activities, use of crutches and other supportive care. A well-balanced diet rich in calcium and vitamin D is also important. In severe, long-lasting cases, medications such as bisphosphonates may be used. In most cases, complete recovery of bone occurs.

Juvenile primary osteoporosis is a skeletal disorder characterized by thinning of the bones (osteoporosis) that begins in childhood. Osteoporosis is caused by a shortage of calcium and other minerals in bones (decreased bone mineral density), which makes the bones brittle and prone to fracture. Affected individuals often have multiple fractures in the long bones of the arms and legs, especially in the regions where new bone forms (metaphyses). They also have fractures in the bones that form the spine (vertebrae), which can cause collapse of the affected vertebrae (compressed vertebrae). Multiple fractures can cause bone pain and lead to movement problems.

In very rare cases, doctors cannot identify the cause of osteoporosis in a child or teen. This condition is known as idiopathic juvenile osteoporosis. The first signs are often fractures, which may lead to a limp and pain in the back, hips, and feet.

Idiopathic juvenile osteoporosis usually starts just before puberty in boys or girls who are otherwise healthy. This condition is usually diagnosed when the doctor cannot find an underlying cause, such as another disease or medication.

If your child has idiopathic juvenile osteoporosis, their growth might be affected by fractures. But they will probably grow normally again within a few years. Most children with idiopathic juvenile osteoporosis catch up with the growth they missed. But if the disease is severe, it can have permanent effects, such as deformities.

Juvenile osteoporosis is usually caused by an underlying medical condition, medications used to treat the condition, or certain behaviors related to diet and exercise.

Some of the diseases that can affect bone mass and increase the risk of juvenile osteoporosis include:

• Celiac disease.
• Cerebral palsy.
• Cystic fibrosis.
• Eating disorders.
• Juvenile idiopathic arthritis.
• Kidney disease.

Some of the medications for these and other diseases that can affect bone mass include:

• Anticonvulsant medications (used to prevent or treat seizures).
• Corticosteroids.
• Cyclosporine.
• Medications that suppress the immune system.

Some behaviors can also affect children’s bone mineral density and risk of osteoporosis, such as:

• Being inactive for a long time because of an injury or another disease, like cerebral palsy.
• Eating an unhealthy diet, particularly if it doesn’t have enough calcium and vitamin D.
• Exercising too much, especially if it causes a teen girl’s monthly periods to stop.

From birth through their 20s, most people steadily gain bone mass until their bones reach their peak strength and density. The greater their peak bone mass, the lower their risk of osteoporosis later in life.

Juvenile osteoporosis develops during the major bone-building years and can affect a child’s growth and development. It can lead to:

• Loss of height or delayed growth.
• A high risk of fractures.

With juvenile osteoporosis, it is important to identify and treat the known underlying causes. Also, if your child takes a medication that could lower bone mass, the doctor might choose the lowest possible dose that controls the disease to minimize its impact on bone health. In addition, your child might benefit from a diet rich in calcium and vitamin D (or supplements) and physical activity.

Medications that are approved by the U.S. Food and Drug Administration (FDA) to treat osteoporosis in adults are sometimes used to treat juvenile osteoporosis. Doctors might recommend these medicines for children who have had several fractures in the vertebrae and severe bone pain.

Children and teens with juvenile idiopathic osteoporosis might not need treatment because the condition often goes away on its own.

• Physical therapy.
• Regular therapy exercise.
• A diet rich in calcium and vitamin D.

The foods we eat contain a variety of vitamins, minerals, and other important nutrients that help keep our bodies healthy. We need to get enough of two nutrients in particular, calcium and vitamin D, to help keep our bones strong.

What does calcium do for our bones?

Calcium is a mineral. Our bodies contain many different minerals, such as iron and magnesium, but the most abundant mineral in the body is calcium.

Also, our bones are partly made of calcium salts (mixtures of calcium with other minerals), especially calcium phosphate. Calcium phosphate hardens and strengthens bone.

Our bodies cannot make calcium. We need to get calcium from foods and drinks, and supplements when needed, to build strong bones and teeth and to keep them healthy. Healthy bones are less likely to break if we fall.

What happens to our bones without enough calcium?

Calcium does more than build strong bone. It also helps our muscles, heart, and nerves work properly.

If we do not get enough calcium in our diets, our body takes the calcium we need from our bones. Over time, this process makes bones weaker and raises the risk of osteoporosis. Osteoporosis is a disease that makes bones weak and brittle, and people with osteoporosis have a higher risk of fractures (broken bones).

How much calcium do we need?

The amount of calcium each person needs depends on their age and sex. Table 1 lists how much calcium people need every day to keep their bones strong and healthy.

Table 1

Source: National Institutes of Health Office of Dietary Supplements

What foods have calcium?

The best food sources of calcium are milk and other dairy products, like cheese and yogurt. Other food sources of calcium include:

• Fish (such as salmon and tuna).
• Leafy green vegetables (such as kale and turnip greens).
• Tofu (set with calcium).
• Small fish with bones (including sardines and canned salmon).

Some foods and drinks are fortified with calcium. A food is fortified when the manufacturer adds vitamins or minerals that the food does not naturally have. Examples of foods fortified with calcium are certain brands of juice, soymilk, oatmeal, and breakfast cereal.

Some supplements contain calcium. Talk to your health care provider if you are thinking about taking a calcium supplement.

What does vitamin D do for our bones?

Vitamin D promotes bone health in these ways:

• Helps absorb the calcium we get from food.
• Along with calcium, helps protects older adults from osteoporosis.
• Promotes healthy functioning of our muscles and immune system. We need strong muscles to help us balance and reduce the risk of falling and breaking bones.

What happens to our bones without enough vitamin D?

When children do not get enough vitamin D, they can develop rickets. With rickets, the bones are soft, weak, deformed, and painful.

In adults, too little vitamin D over time can cause:

• Osteomalacia, a painful condition that makes bones and muscles weak and more likely to bend and break.
• Osteoporosis.

How much vitamin D do we need?

Table 2 lists how much vitamin D people need every day to keep their bones healthy.

Table 2

Source: National Institutes of Health Office of Dietary Supplements

In the United States, most people do not consume enough vitamin D to meet recommended intakes. Some vitamin D can be made in the body with sun exposure. Still, many people have low vitamin D status.

What foods have vitamin D?

Not many foods have vitamin D. Some kinds of fish can provide some of the vitamin D we need each day. Examples are:

• Trout.
• Salmon.
• Tuna.
• Mackerel.

Most of the vitamin D that Americans get from food comes from fortified foods. Most milk and some yogurts in the United States are fortified with vitamin D, but most other dairy products do not have added vitamin D.

Other foods that may be fortified (check the label to be sure) include:

• Ready-to-eat breakfast cereals.
• Orange juice.

Some supplements contain vitamin D. Talk to your health care provider if you are thinking about taking a vitamin D supplement.