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Optimizing bone health in children and adolescents
Insights
Pediatricians can optimize children's bone health by encouraging adequate calcium and vitamin D intake, focusing on diet over supplements. This guidance helps build strong bones throughout childhood and adolescence.
Area of Science:
- Pediatrics
- Bone Health
- Nutrition
Background:
- Bone health is crucial during childhood and adolescence for lifelong skeletal integrity.
- Pediatricians play a key role in guiding bone health optimization in young individuals.
- Understanding normal bone acquisition and influencing factors is essential.
Purpose of the Study:
- To review normal bone acquisition in pediatric populations.
- To discuss factors impacting bone health in children and adolescents.
- To provide updated clinical guidance on calcium, vitamin D, and physical activity.
Main Methods:
- Review of current literature on pediatric bone health.
- Updated recommendations for daily calcium and vitamin D intake.
- Guidance on weight-bearing activities and supplementation strategies.
- Discussion of diagnostic tools like dual-energy x-ray absorptiometry (DXA) and interpretation methods (z-scores).
Main Results:
- Increased dietary calcium intake is encouraged for healthy children and adolescents.
- Higher recommended dietary allowances for vitamin D are endorsed.
- Vitamin D deficiency testing is supported for those with bone fragility conditions.
- Routine universal screening for vitamin D deficiency is not recommended due to insufficient cost-benefit evidence for fracture risk reduction.
Conclusions:
- Pediatricians should focus on promoting adequate dietary intake of calcium and vitamin D.
- Supplementation is not routinely recommended for healthy children.
- DXA interpretation in pediatrics requires specific considerations, such as using z-scores.
- Office-based strategies can help pediatricians optimize bone health in their patients.
Abstract:
The pediatrician plays a major role in helping optimize bone health in children and adolescents. This clinical report reviews normal bone acquisition in infants, children, and adolescents and discusses factors affecting bone health in this age group. Previous recommended daily allowances for calcium and vitamin D are updated, and clinical guidance is provided regarding weight-bearing activities and recommendations for calcium and vitamin D intake and supplementation. Routine calcium supplementation is not recommended for healthy children and adolescents, but increased dietary intake to meet daily requirements is encouraged. The American Academy of Pediatrics endorses the higher recommended dietary allowances for vitamin D advised by the Institute of Medicine and supports testing for vitamin D deficiency in children and adolescents with conditions associated with increased bone fragility. Universal screening for vitamin D deficiency is not routinely recommended in healthy children or in children with dark skin or obesity because there is insufficient evidence of the cost-benefit of such a practice in reducing fracture risk. The preferred test to assess bone health is dual-energy x-ray absorptiometry, but caution is advised when interpreting results in children and adolescents who may not yet have achieved peak bone mass. For analyses, z scores should be used instead of T scores, and corrections should be made for size. Office-based strategies for the pediatrician to optimize bone health are provided. This clinical report has been endorsed by American Bone Health.
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