OSTEOPOROSIS IN CHILDREN

What is it about?
Osteoporosis is a progressive decrease in bone density, which weakens the bones and makes them break more easily.

Who gets it?
Osteoporosis in children is a rare condition.

What causes it?
Osteoporosis in children can be caused by other medical conditions or the medications used to treat them. This is called secondary osteoporosis, and most often occurs with diseases such as juvenile rheumatoid arthritis, dermatomyositis (a skin condition), asthma, inflammatory bowel disease, hormonal disorders, and muscular dystrophy.

All of these conditions are treated with corticosteroids, which have been shown to cause a decrease in bone mass. These conditions may also limit a child's physical activity, which is essential in building bone mass. Secondary osteoporosis can also be caused by anorexia nervosa, an eating disorder. Some children have genetic disorders, which are present at birth, that prevent the bones from forming properly, such as osteogenesis imperfecta (OI). When the cause of osteoporosis is unknown, it is called idiopathic juvenile osteoporosis (IJO).

What are the symptoms?
Children with osteoporosis may complain of an aching pain in their bones. Their bones break easily from a simple fall, called an atraumatic fracture. Children with osteogenesis imperfecta (OI) have bones that break very easily, with little or no trauma. Symptoms range from mild to severe, with some children suffering hundreds of fractures in their lifetime.

Idiopathic juvenile osteoporosis (IJO) occurs in seemingly healthy children between the ages of 8 and 14, just before puberty begins. Symptoms include atraumatic fractures, often in the lower limbs; pain from the lower back down to the ankles; and difficulty walking. IJO usually runs a course of two to four years, then goes away without any permanent disability or growth problems.

How is it diagnosed?
Osteoporosis in children is diagnosed through a combination of symptoms, a physical examination, and bone x-rays. Some screening methods used to measure bone density in adults can also be used in children, such as a technique called heel ultrasound. These types of techniques can be useful in monitoring bone density in children who are at risk for developing osteoporosis because of existing medical conditions.

What is the treatment?
Secondary osteoporosis is treated by effectively treating the underlying medical condition and monitoring the amount of medication given to treat the condition. Your doctor will make sure the smallest effective dose is prescribed, or that an alternative medication is used if possible. Osteogenesis imperfecta (OI) and idiopathic juvenile osteoporosis (IJO) are treated by protecting the spine and other bones from fracture.

Prevention and treatment of osteoporosis
The best medicine for osteoporosis is prevention, and the time to act is during childhood. This is what you can you do for your child to optimize his or her peak bone mass:

• Make sure your child takes enough calcium and vitamin D, and keep your child active. A recent study showed that teenagers in the United States frequently have inadequate calcium intake, and their calcium intake is inversely correlated with soda pop intake—meaning that the more pop they drink, the less calcium they are likely to get! Current recommendations for calcium intake are shown in the accompanying table.
For teenagers, this translates into four servings from the low-fat dairy products, such as milk, cheese, and yogurt daily. Fortified soy milk is a nice choice for calcium because in the U.S. milk is supplemented with vitamin D, which helps the body utilize calcium.

• Other important sources of calcium include yogurt and cheese, sardines, canned salmon with bones, cabbage, leafy greens, all kinds of meat, and calcium-fortified foods, such as orange juice. Vitamin D is found in supplemented milk, but is also made by the body when skin is exposed to sunlight. Calcium supplements are available by prescription, but are also found in some antacids (for example, Tums and Rolaids). Ask your doctor if your child might benefit from calcium supplementation.

• If you have a strong family history of osteoporosis, or if your child is taking steroids, ask your doctor about the possibility of getting a DEXA scan done. Keep in mind, however, that one of the problems with childhood osteoporosis is that treatments have been geared towards adults. Treatment for osteoporosis in childhood has not been established and should be considered experimental.
There is more research needed on bone health in children and prevention or treatment of childhood osteoporosis. Until then, helping your child prevent osteoporosis with the steps outlined above is the best course of action.

Calcium Intake Recommendations by Age Group Age Group Calcium Goal (mg/day)
1-3 years 500
4-8 years 800
9-18 years 1,300
Pregnant 1,300
19-50 years 1,000

The health information supplied is intended to be a supplement to the care provided by your physician. It is not intended nor implied to be a substitute for professional medical advice

How To Manage Your Blood Pressure

High Blood Pressure (BP) is a treatable condition but it can cause serious damage to your organs if left untreated.

If you have been recently diagnosed with high BP, you might be taking medication to bring the numbers down, lifestyle changes such as those listed below will help the effectiveness of your medications, and sometimes reduce the dose you require to control your Blood Pressure. Lifestyle changes are useful adjuncts to medications, and for those with a normal blood pressure, will help maintain a normal blood pressure over time. It is not advisable for you to stop your prescribed medications for lifestyle changes without the consent of your physician.

Shed the weight: Losing weight can help lower BP because BP tends to increase as weight increases. One way to achieve this is by watching what you eat and increasing your physical activity to help burn off more calories. You need a negative calorie balance, that is, burn more than you take in, to lose weight

Physical Activity and Exercise: Forty five minutes of moderate exercise such as brisk walking, jogging, swimming, and so forth, three to four times a week will help improve your blood pressure and weight control.

Sleep Well: Good night sleep is important for maintaining good health. A good night sleep relaxes the body and lowers your stress levels. An additional 15 to 20 minutes nap during the day can be very refreshing. A minimum of six hours of sleep a night is recommended.

Avoid too much salt: High salt intake increases the likelihood of developing high blood pressure in predisposed individuals. It is important to keep your salt intake low. This is achieved by avoiding adding salt to food on the table. Fast foods and canned foods such as corned beef, sardine, and many food seasonings like Maggi, also contain lots of salt and should be consumed sparingly.

Limit alcohol consumption: Moderation of alcohol intake is helpful to keep blood pressure and body weight under control. Excessive alcohol intake is injurious to health. Excess alcohol refers to more than one drink a day for women and more than two for men. Note that “A drink” is one can of beer, or one glass of wine or equivalent.