Childhood Osteoporosis and Rare Bone Diseases: An Overview

Introduction

The skeletal framework that holds the body in a particular shape is predominantly by the bones. These bones are made up of cells that are different from the other tissue cells of the body and are mainly composed of materials like calcium. These bones in the body are solid, giving a person physical strength and endurance. However, specific clinical scenarios affect these bony structures by altering their composition, cellular framework, physical shape, or strength. While these triggering conditions can be due to various reasons, there is an overall compromise in the functioning of the bones.

What Are the Rare Bone Diseases Seen in Children?

Rare bone diseases are clinical conditions that are very unlikely to be seen in the everyday population but can rarely occur in certain people or children. These rare diseases in children are often seen due to various factors like nutritional deficiency, poor socioeconomic conditions they live in, improper immunization of the children, inadequate health care, genetic factors, developmental defects, etc. Some of the rare bone diseases seen in children are:

• Osteoporosis: It is a clinical condition characterized by poor bone density, commonly due to aging or hormonal imbalances, leading to weak bones that are more prone to fracture.

• Osteopetrosis: A rare genetic condition seen by extremely dense but very brittle bones, which can result in bony fractures, bone defects, or compression of the nerves.

• Marfan’s Syndrome: It is a connective tissue condition where the person is tall with longer limbs and excessive joint mobility, associated with heart problems like rupture of the aorta (largest blood valve).

• Osteogenesis Imperfecta: This is a clinical condition seen in very fragile bones that are more prone to fractures, commonly due to a genetic defect affecting collagen production.

• Rickets: This condition occurs due to a deficiency of vitamin D, leading to softer, fragile bones with defective or retarded skeletal growth.

• Paget's Disease: This disease occurs due to abnormal remodeling of the bone, leading to large, weak bones that are more prone to fractures and developmental deformities, with a greater potential risk for bone cancer.

• Skeletal Dysplasia: This is a genetic disorder affecting the growth and development of bone and cartilage, resulting in skeletal deformities, joint issues, and retarded growth.

• Fibrous Dysplasia: Here, the fibrous tissue replaces regular bone, resulting in weak and abnormal bones that are highly prone to fractures.

• X-Linked Hypophosphatemia: It is an acquired disease due to low levels of phosphate in the blood, leading to weak bones.

What Is Childhood Osteoporosis?

Childhood osteoporosis is also called juvenile osteoporosis, a clinical condition seen in young children due to the softening of the bones. The condition is considered bothersome as it can progress with age, making the child's bones more fragile. This, in turn, can affect their growth, mental well-being, and ability to play or perform activities, making it more complicated for them to achieve their everyday day-to-day lives. Although osteoporosis or softening of the bones is seen to be a common problem in adults as age progresses, it is considered rare in children.

What Are the Factors Causing Childhood Osteoporosis?

Many factors lead to the occurrence of osteoporosis in children; the primary causes are genetic conditions where defective genes are inherited from the parents and lack of nutrition. In many clinical situations, childhood osteoporosis is also triggered by various underlying clinical conditions like diabetes (increase in blood sugar levels), increased thyroid levels in the body, inflammatory bowel diseases (a clinical condition associated with stomach pain and diarrhea), kidney diseases, Cushing’s syndrome (condition seen due to an increase in cortisol hormone levels), anorexia, cystic fibrosis (it is a genetic condition affecting the lungs and digestive system), etc.

The other uncommon reasons include incidence due to adverse effects of drug intake, where the children are prescribed long-term medications for conditions like cancer, fits (epilepsy), breathing trouble, inflammatory diseases of the bone, etc., and lifestyle conditions like poor social status leading them to habits like smoking or alcohol abuse, lack of nutrition and high weight bearing labor.

How Is Childhood Osteoporosis Clinically Seen?

Normally, in childhood, there is an aberrant build-up of the bone masses seen, helping in the growth and maturation of the children. However, in childhood osteoporosis, the children tend to have a shallow bone mass, which directly affects the structural integrity of the skeletal framework. Because of this reason, children with juvenile osteoporosis appear to be much weaker in stamina, have less bone strength, compromised bone growth and maturation, have slower maturation rates at puberty, mentally and emotionally weaker kids.

What Are the Diagnostic Tests for the Detection of Osteoporosis in Children?

The diagnostic tests that are performed for identifying osteoporosis in children are as follows:

• By thoroughly collecting the child’s clinical history and past, present, and family history.

• By performing clinical examinations.

• Extraction of family history is of great importance because it gives us an insight into what could have triggered the disease in the first place and ways to manage it.

The Clinical Tests Include:

• X-ray: A two-dimensional radiographic imaging test performed using radiation to examine the presence of any defect in the bone.

• DEXA Scan: This is also known as the bone density test. This test is done by performing a double X-ray that gives us an idea of the strength and thickness of the bones. This is done by alternatively passing both low and high-energy radiation into the bones.

• Blood Test: Blood or serum tests are done where the samples are collected and tested for the thyroid hormone, vitamin D, and calcium levels in the blood as they influence the strengthening of the bone.

How Is Childhood Osteoporosis Treated?

To stop childhood osteoporosis and achieve successful regeneration of bones, it is mainly important to identify the cause and treatment of it. So, the treatment protocol is as follows:

• Careful diagnosis and monitoring of the condition.

• If the children are under any medication that affects bone health, it should be limited or altered.

• Encouraging the children to participate in regular exercises that are easy and comfortable for them.

• Increasing dietary calcium and vitamin D levels through food or supplements helps strengthen the bones and multiply the bone cells.

• Getting adequate sunlight.

• Protecting the children from over-exerting activities that can lead to fractures.

• Prescribing medications that give them energy as well as reduce pain gives them palliation.

Conclusion

The need for addressing osteoporosis in children is very important as it can affect their mental and physical strength, which can be taxing to both the child and the parents. So, it is essential to educate parents who are expecting a baby or have children about the possible reasons causing childhood osteoporosis and how it can be prevented. Spreading knowledge and including proper dietary habits will encourage better health in children from a very young age, preventing the development and progression of the disease.