Osteoporosis (Children)

Osteoporosis, a condition where bones become less dense and more prone to fractures, is predominantly seen in the elderly but can also occur in children. Not all fractures in children are due to osteoporosis; some result from high-impact trauma.

Cultivating healthy nutritional and lifestyle habits in childhood is key to preventing osteoporosis and fractures later in life. Peak bone mass, which is reached by late twenties, is crucial for long-term bone health.

Factors Affecting Peak Bone Mass

Peak bone mass is influenced by factors, including:

• Gender: Generally, men have higher bone mass than women.
• Race: African American girls usually achieve higher peak bone mass than Caucasian girls, reducing their risk of osteoporosis. Conversely, Asian girls often have lower bone mass, which increases their risk of osteoporosis.
• Hormonal factors: Sex hormones, including oestrogen and testosterone, are essential for bone mass development.
• Nutritional status: Calcium and vitamin D are essential for bone health.
• Physical activity: Regular physical activity is important for building healthy bones.

In children, osteoporosis is typically secondary to another medical condition or medication used to treat such conditions. It can also result from genetic disorders such as Osteogenesis Imperfecta. Conditions that increase the risk of osteoporosis include:

• Rheumatological conditions like Juvenile Arthritis or Lupus
• Neuromuscular disorders like Cerebral Palsy, Duchenne Muscular Dystrophy, Immobilisation
• Endocrine conditions like Hyperthyroidism, Hyperparathyroidism, Cushing's Syndrome, Delayed Puberty
• Malabsorption Syndromes
• Anorexia Nervosa
• Kidney or liver diseases

Certain medications (e.g. anticonvulsants, corticosteroids) and behaviours (prolonged inactivity, inadequate nutrition, excessive exercise) can also increase osteoporosis risk.

Frequent low-impact fractures might indicate osteoporosis. Consult with your child’s doctor if you have concerns about frequent fractures or if your child has a medical condition that could impair bone development.

Consult a paediatric endocrinologist for an assessment of your child's bone health fracture risk. Treatment will vary based on the underlying cause.

• Ensure your child has a diet rich in calcium and vitamin D
• Encourage weight-bearing physical activities like walking, running, dancing and team sports
• Limit caffeine and alcohol intake, and discourage smoking
• Set a positive example by adopting healthy habits yourself

Useful Links

• https://www.healthhub.sg/live-healthy/192/recommended_dietary_allowances

Continued clinical research is essential for advancing paediatric healthcare. Our doctors are committed to contributing to the future of child health and medicine through both clinical practice and research.

1. Goh SY, Aragon JM, Lee YS, Loke KY (2011).
   Normative data for quantitative calcaneal ultrasound in Asian Children.
   Annals of the Academy of Medicine, Singapore, 40(2):74-9.