Question of the Week

December 18, 2006


Many people have heard of osteoporosis.  

Osteoporosis: "a disorder in which the bones become increasingly porous, brittle, and subject to fracture, owing to loss of calcium and other mineral components, sometimes resulting in pain, decreased height, and skeletal deformities: common in older persons, primarily postmenopausal women, but also associated with long-term steroid therapy and certain endocrine disorders."

When most people think of osteoporosis, they usually think of older women. Teens (especially girls) may have heard from parents or doctors that they need to care for their bodies now in order to avoid the disease in the future...

"Here are several reasons why teens should be concerned about osteoporosis:
*During the teen years, almost one-half of the adult skeleton is formed.
*Less than half of all teens get enough calcium every day. For teenage girls, the statistics are even worse-only 15 percent of them get enough calcium!
* If you build your bones when you're in your teens, you will be less likely to fracture your bones when you're older."

While children and teens are often not concerned about something that will not have consequences until later in life, doctors stress that it is something all people need to be careful about -- even when they are young.

"Osteoporosis is a silent disease that can often be prevented. However, if undetected, it can progress for many years without symptoms until a fracture occurs. It has been called 'a pediatric disease with geriatric consequences,'
because building healthy bones in one’s youth will help prevent osteoporosis and fractures later in life."

For some teens and young adults, the consequences will be come earlier. Those who are on extreme diets -- or are suffering from an eating disorder -- are contributing to more significant losses in bone density for both females and males.

"Anorexia nervosa has significant physical consequences. Affected individuals can experience nutritional and hormonal problems that negatively impact bone density. Low body weight in females causes the body to stop producing estrogen, resulting in a condition known as amenorrhea, or absent menstrual periods. Low estrogen levels contribute to significant losses in bone density. In addition, individuals with anorexia often produce excessive amounts of the adrenal hormone cortisol, which is known to trigger bone loss. Other problems -- such as a decrease in the production of growth hormone and other growth factors, low body weight (apart from the estrogen loss it causes), calcium deficiency, and malnutrition -- contribute to bone loss in girls and women with anorexia. Weight loss, restricted dietary intake, and testosterone deficiency may be responsible for the low bone density found in males with the disorder."

Children and teens often think that their bodies are strong enough to handle almost anything. While some cases of
juvenile osteoporosis are unexplained or brought on by disease, others can be brought on by medication or lifestyle choices.

"Osteoporosis in children (juvenile osteoporosis) is rare. When it does occur, it is usually due to a medication or underlying medical condition. Doctors refer to this as secondary osteoporosis. ... The most common sign or symptom of juvenile osteoporosis is a fracture that occurs with minimal trauma. A doctor can diagnose a fracture by X-rays of the affected bone. Treatment of secondary osteoporosis is directed at the underlying cause. In rare cases, the cause of juvenile osteoporosis can't be determined. Doctors refer to this as idiopathic juvenile osteoporosis. This rare form of osteoporosis typically occurs in previously healthy children between the ages of 4 and 16. Signs and symptoms include pain in the lower back, hips and feet, and difficulty walking."

Idiopathic juvenile osteoporosis is rare. Many people with osteoporosis will not have symptoms until they have broken a bone.

"Persons with osteoporosis may not develop any symptoms and the disease, therefore, is often called silent. ... Diagnosis of juvenile osteoporosis is often not made until the child has a broken bone. In addition to a complete medical history and physical examination, diagnostic procedures for juvenile osteoporosis may include:
*family medical history
*skeletal x-rays - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
*bone density test - a diagnostic procedure to determine bone mineral content and skeletal changes, such as bone loss.
*blood tests (to measure serum calcium and potassium

Since osteoporosis is rare in healthy children, these test are not routinely done for children or teens.  

"What causes my risk for osteoporosis? 
*Not getting enough calcium.
* Females are four times more likely than males to develop osteoporosis. 
* Drinking too many soft drinks-teens who drink lots of soda often drink less milk. 
* Too little physical activity-regular physical activity that puts weight on your bones, like walking, running, playing basketball or dancing, helps prevent osteoporosis. 
* Race plays a role-African Americans have a lower risk because their bones are usually stronger and more dense than Caucasians and Asians.
* Family history-other people in the family with osteoporosis.
* Smoking causes bone loss."

Healthy teens still need to do all they can to reduce their risk factors and prevent osteoporosis.

"What can I do to prevent osteoporosis? 
*Eat lots of calcium-rich foods like milk, yogurt and cheese; calcium-fortified orange juice and bread; green leafy vegetables like collards and kale; canned salmon and sardines or tofu. 
* If you don't eat dairy products, it may be necessary for you to take a calcium supplement to meet your high calcium needs as a teen. Talk to your doctor or a registered dietitian before taking any type of supplement. 
* Get some type of weight-bearing physical activity every day. 
* Limit soft drink consumption to one or less a day."

Even those with fewer risk factors still need to do all they can to prevent the disease. While women and girls are often reminded by doctors and parents to get enough calcium, "being female" is just one factor that increases the risk of developing the disease.  

"[R]emember that 20 percent of the osteoporotic population is male. We tend to assume that what we learn about women
will apply to men, but this is not necessarily the case. Is lifelong low-calcium intake bad for men, as it is for women? A woman whose mother or grandmother had osteoporosis is at greater risk. We assume the same familial disposition for a man, but we don't know. By asking what the differences are between the genders, we hope to glean information that will apply to prevention and treatment in men. ... One interesting piece of information is that some men who have sustained an unlikely fracture in childhood are at greater risk of developing osteoporosis later in life."

Questions of the Week:  
What do your friends, siblings, and parents need to know about osteoporosis? How might the information they need vary based upon their age, gender, and stage of life? What can children, teens, and adults do to reduce their risk factors and increase their chances of preventing the disease? What would be the best way to reach them with this information so they would see the need and make the lifestyle changes that may be necessary?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

[email protected]
Health Community Coordinator
Access Excellence @ the National Health Museum

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