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Stronger bones, stronger health

Dr. Suhail Afzal

(Consultant Orthopaedic and Spine Surgery, Gousia Hospital)



What are the frequent bones related problems and disorders in children?

Growing pain is part and parcel of the growing phase in a child’s life. When the child stops growing so will the growing pain and when adolescence is reached, they disappear completely. Growing pain can occur between three to five years or eight to twelve years of age.

Sprains and strains are among the majority of the injuries caused while playing sports. Sports injuries can be caused by small trauma which involves ligaments, muscles and tendons including bruises, sprains and strains. Rickets from Vitamin D deficiency, Osteogenesis Imperfecta, Renal Osteodystrophy are some other bone related issues that can occur in youth. Juvenile Osteoporosis is where youngsters start losing calcium from bones.

What is juvenile osteoporosis and how can it be treated?

Juvenile osteoporosis often occurs in children between the ages of 8 and 14. It sometimes develops in younger children during growth spurts. Juvenile osteoporosis in children is hard to define. There are two kinds of juvenile osteoporosis: secondary and idiopathic. Secondary osteoporosis refers to osteoporosis that develops as a result of another medical condition. This is by far the most common kind of juvenile osteoporosis. Idiopathic osteoporosis means that there is no known cause of the disease. This type of juvenile osteoporosis is much less common. Boys have the condition more often than girls. It develops most often just before the onset of puberty. No matter what the cause, juvenile osteoporosis is a very serious condition. You build about 90 percent of your bone mass by the time you are 18 to 20. Losing bone mass during prime bone-building years can put a child at serious risk for long-term complications such as fractures.

The type of treatment your child gets depends on the cause of osteoporosis. If juvenile osteoporosis has been caused by an underlying disease, the best way to treat the osteoporosis is to treat that disease. All children, including those with juvenile osteoporosis, need a lifestyle that helps build healthy bones. This includes a diet rich in calcium, vitamin D, and protein, and as much safe physical activity as possible. It's best to avoid caffeine. Many experts also suggest that children with juvenile osteoporosis have their bone density monitored at least every other year into adulthood. School-aged children are still growing. Growth requirements combined with physical activity play a role in determining a child's nutritional needs. Genetic background, gender, body size and shape are other factors. The nutrients needed by children are the same needed by adults, but the amounts vary.

There are also a variety of vitamins and minerals which support growth and development during childhood. Calcium, obtained from milk and dairy products and from dark green, leafy vegetables, is usually sufficient nutritionally in the diets of young children. As children approach teen years, their dietary calcium intakes do not always keep up with recommended daily allowances. Calcium is particularly important in building strong bones and teeth.

During teenage or the growing years, is there a need for extra care of bones and their health?

Adequate nutrition and physical activity help to increase or preserve bone mass and to reduce the risk of falling. All types of physical activity can contribute to bone health, albeit in different ways. Calcium and Vitamin D is important for good bone health as Vitamin D aids in the absorption and utilization of calcium. Maintaining a healthy body weight is important for bone health.

How common is calcium deficiency in young boy and girls and what are the major reasons?

Adolescence is the transition period between childhood and adulthood, a time of life that begins at puberty. For girls, puberty typically occurs between ages 12 and 13, while for boys it occurs between ages 14 and 15. It is one of the fastest growth periods of a person's life. During this time, physical changes affect the body's nutritional needs, while changes in one’s lifestyle may affect eating habits and food choices. Nutritional health during adolescence is important for supporting the growing body and for preventing future health problems. Most kids in ages 9 to 18 don't get the recommended 1,300 milligrams of calcium per day and the requisite dosage of Vitamin D3, inadequate exposure to sunlight. Irregular eating and snacking habits, fast foods, inadequate physical activities also lead to calcium deficiency.

Are girls more affected? If yes, why?

According to a 2010 study published in The Journal of Nutrition, 86 percent of teen girls do not get enough calcium in their daily diets. While you may believe calcium is just a concern for older women, most are surprised to learn that teen girls actually require more calcium per day than even their mother or grandmothers. Calcium plays an important role in strengthening bones and teeth, as well as helping muscles (including the heart) and nerves function properly. With 95 percent of the peak bone mass present by age 20, experts in bone health agree that getting the proper amount of daily calcium during these adolescent years is crucial.

Does the sedentary lifestyle of youngsters affect their bone health and over-all growth?

The skeleton grows from birth to the end of the teen years and bones reach their maximum strength and size in early adulthood. Nutrition and physical activity are major factors in bone growth. Therefore, a sedentary lifestyle can have a negative impact.

Does Kashmir's cold climate affect the overall bone health of youth?

Lack of sunlight and reduced level of activities are the factors which can affect the overall bone health.

What are the repercussions of poor bone health in youth at a later age?

Adolescence is a particularly critical period for bone health because the amount of bone mineral gained during this period typically equals the amount lost throughout the remainder of adult life. Failure to achieve an optimized bone mass at the end of adolescence leaves an individual with much less reserve to withstand the normal losses during later life. Most gains in bone mass during puberty are due to an increase in bone length and size rather than bone density. Fracture rates go up during this period of extremely rapid growth, possibly because the bone is temporarily weaker because bone mineralization lags behind growth in bone length. After individuals achieve peak bone mass in late adolescence, bone health is optimized by maintaining as much of this bone mass as possible throughout adulthood.

Does exercise help?

Lifestyle change also plays an important role in restoration of bone health among adolescents. For teenagers who do not follow a regular exercise regimen, a weight-bearing physical activity routine in order to exert biomechanical forces on the bone to promote healthy growth is required.

What kind of lifestyle or foods would you suggest to youngsters in order to maintain good bone health?

Physical activity is a critical component of overall health, and bone health, in particular, relies on weight-bearing activity during the first few decades of life to achieve maximal potential. Athletic pursuits that place a high premium on physical appearance and/or weight (wrestling, dance, long-distance running) should trigger questions about daily nutritional intake and restricting behaviors. In addition to the other benefits of regular physical activity, athletic pursuits often take place outside, where adolescents are exposed to ultraviolet B radiation, thereby increasing vitamin D production. Hours of sun exposure during the day can provide a general guide for vitamin D status. However, seasonal variation in light exposure can be misleading, particularly for persons who live in northern latitudes.

A well-balanced diet is important for bone health throughout life. The Institute of Medicine recommends a steady increase in calcium intake as children age, beginning with 210 mg per day in infants and rising to 1,300 mg per day in those age 9–18.

  • Title: Stronger bones, stronger health
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