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Pediatrics group issues new recommendations for building strong bones in kids

MilkshelfOur bones function as retirement-savings accounts for calcium: We deposit the mineral into our bones when we're young, then draw on the stores as we age. Too little calcium in the "savings account" puts people at risk for osteoporosis and debilitating bone fractures later in life.

This means that, although osteoporosis is usually seen as a disease of old age, pediatricians and parents need to pay attention to bone health. This week, the American Academy of Pediatrics released updated guidelines for pediatricians on how nutrition and exercise can improve bone density in their patients. The guidelines were co-authored by Stanford's Neville Golden, MD, who is also an adolescent medicine specialist at Lucile Packard Children's Hospital Stanford. The report discusses calcium, which strengthens bones; vitamin D, which helps the body absorb calcium; and weight-bearing exercise, which promotes calcium deposition into the bones.

In addition to protecting against fractures in old age, the guidelines address the needs of kids whose bones are weakened by a variety of childhood and adolescent medical conditions, including juvenile osteoporosis, cystic fibrosis, lupus, celiac disease, cerebral palsy and anorexia nervosa.

A few highlights from the recommendations:

  • Children and adolescents should get their calcium mostly from food, not supplements. To meet calcium requirements, the committee recommends three or four daily servings of dairy foods (depending on the child's age) and also suggests alternative food sources such as dark green veggies, beans, and calcium-fortified orange juice or breakfast cereals.
  • Vitamin D recommendations went up in 2011; the AAP agrees with the increased recommendations for all children and notes that kids using certain medications have even higher requirements than healthy children. Although the body can make vitamin D from sunlight, the report notes that kids are spending more time indoors and that sunscreen prevents vitamin D synthesis, making children more reliant on food and supplements to get enough vitamin D.
  • Soda often displaces milk in children's diets, adding bone health to the list of reasons doctors should discourage soda consumption.
  • Weight-bearing exercise helps strengthen the bones. The report recommends activities such as walking, jogging, jumping and dancing over exercises such as swimming and cycling for building bone health.
  • Adolescent girls with eating disorders such as anorexia nervosa and the female athlete triad experience bone loss. In the past, some physicians have suggested that these young women could improve their bone density by taking oral contraceptives, but the report notes that randomized controlled trials have not found any evidence that oral contraceptives increase bone mass for these patients.

Previously: Goo inside bones provides structural support, study finds, New genetic regions associated with osteoporosis and bone fracture and Avoiding sun exposure may lead to vitamin D deficiency in Caucasians
Photo by Stephanie Booth

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