Boning Up on Kids’ Health

“Typically, when parents think about their children’s health, they don’t think about their bones,” says Dr. Patricia Poitevien, director of pediatrics at the NYU Hospital for Joint Diseases in Manhattan. “But parents and pediatricians alike underestimate how often osteoporosis afflicts children. We believe it is a greatly under-diagnosed condition.”

Dr. Poitevien directs the Initiative for Pediatric Bone Health, an outpatient clinic affiliated with the Center for Children at the Hospital for Joint Diseases. The clinic, open twice a week, treats children with a range of low bone density disorders.

According to the National Institutes of Health, the primary disorders that can affect peak bone mass in children are juvenile arthritis, diabetes, hyperthyroidism, hyperparathyroidism, Cushing’s syndrome, malabsorption syndromes, anorexia nervosa, kidney disease, and liver disease. Other factors include smoking, alcohol abuse, prolonged inactivity, and inadequate nutrition. In addition, situations that can result in pediatric osteopenia and osteoporosis include the extended use of anti-convulsant medications (for epilepsy), steroids (for rheumatoid arthritis and asthma), and immunosuppressive agents (for cancer). Dr. Poitevien notes that children who are wheelchair-bound are also at risk due to prolonged immobility; gender, she says, is not a risk factor.

Osteoporosis in some young patients cannot be explained, Dr. Poitevien adds. This is known as idiopathic juvenile osteoporosis. “We do a full work up on them and we come up with nothing,” she says.

Severe fractures, particularly of the hip and spine, pose the greatest short-term danger for children with poor bone health. “In the long run, we’re concerned about osteoporosis and scoliosis as well,” Dr. Poitevien says.

Poor bone health generally presents itself in pre-adolescence and adolescence. Warning signs include multiple fractures, as well as complaints of constant aching in joints and bones. Patients are often referred to the Initiative for Pediatric Bone Health clinic when, after four or five fractures, their orthopedic surgeon begins to consider other possible causes. The majority are children with osteogenesis imperfecta, a genetic disease that causes the bones to break easily with little or no apparent cause. “We treat a wide array of these patients,” Dr. Poitevien says. “Some have had only one fracture; others have already had 20 or 30.”