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Osteoporosis Prevention

October 01, 2006 By Helen Rose

By Mark B. Levin, M.D. and Louis J. Tesoro, M.D.
The Pediatric Group, P.A., Princeton

This is the 61^th article written by the Pediatric Group, P.A. for Princeton Online

When we think of osteoporosis, children do not usually come to mind. Yet, to prevent osteoporosis, exercise and good nutrition must begin at a younger age than one might suppose. None of us wants to experience the hunched-over painful posture that we have seen in some elderly folks, nor do we wish for the pain and inconvenience of fractures resulting from minor trauma. Strong bones, as we have heard repeatedly, are important for our longevity and health. What many people do not realize, however, is that the interventions for bone health are more effective and have more of a lasting effect in childhood than in adulthood.

The first important factor for bone health is adequate dietary calcium intake. In the absence of an uncommon specific disease that impairs calcium absorption or retention, children can easily acquire all the calcium they need from readily available dietary sources. The calcium content of some foods is listed below. The values vary according to the technique used by each reference institution to measure the amounts.

Food	Calcium (mg)
	Harvard	CDC	Jackson	U of AZ
Broccoli, 2 cups	188	180
Cheddar cheese, 1 oz	204	204
Collards, 1 cup cooked	220	179
Cottage cheese, 1/2 cup	69	69
Fortified Orange juice, 8 oz	300	300
Milk, 1 cup skim	300	300
Mozzarella cheese, 1 oz part skim	183	207
Muenster cheese, 1 oz				200
Ricotta cheese, 1 oz	64	84
Salmon, 3 oz			103	180
Sardines, 8 medium	484
Shrimp, 3 oz				35
Spinach, 2 cups cooked			492
Tofu, 4 oz	258
Turnip greens, 1/2 cup cooked	99
Yogurt, 8 oz plain	400	450

Harvard University
Centers for Disease Control
Jackson Nutrition Health System
University of Arizona School of Agriculture

Despite what has been blared at us from commercials and printed media for years, children do not need very much calcium to meet all their metabolic requirements. A twenty-pound toddler requires only about 300 mg of oral calcium intake per day for growth. A forty-pound child would require about 600 mg per day. The recommended amount for adolescents is 900-1200 mg per day and for adult women is about 1500 mg per day. As can be seen from the table above, these minimums are easily attainable in a healthy diet. Some commonly available dietary calcium supplements include TUMS Regular® (200 mg per chewable tablet), OsCal® (500 mg per tablet), Citrical® (200 mg per tablet), Viactiv® (500 mg per chewable piece) and Flintstones® or Scooby-Doo® Chewables (500 mg per piece). Calcium obtained from food sources is absorbed more efficiently from the gastrointestinal tract than that obtained from supplements. Supplements may cause abdominal cramps. For this reason, a dose of a supplement, if elected, should not be more than one tablet or piece at a time.

Far more important than the amount of calcium intake for a child, is the amount of high impact weight bearing exercise that a child experiences. Studies have demonstrated that without appropriate amounts and types of exercise, the ingested calcium is not deposited in bone, but rather excreted. On the other hand, adequate amounts of high impact weight bearing exercise, even in the face of low calcium intake, enhances bone density. This effect is most apparent in girls aged twelve to sixteen years. High impact exercise includes running (and sports that require running, such as baseball, lacrosse and field hockey, et cetera), jumping (e.g., trampoline* and jump rope), step aerobics and the like. In order to be beneficial, the duration and frequency of the exercise must be at least thirty minutes and daily. We are not suggesting that every child must participate in a competitive sport. Rather, the activity should be commensurate with the child’s style. Some children will prefer jogging or jump rope to team sports. Even if thirty minutes of exercise per day, seven days per week, is not practiced from the start, some weight bearing exercise is better than none. This statement should not be taken to mean that a child can make do with inadequate exercise.

Preventative action is preferable to waiting for incipient osteoporosis. Pediatricians do not routinely order tests to assess bone density in adolescents because the current technology shows variable results for the same individual and imparts an undesirable quantity of radiation. Promising newer and safer techniques that involve ultrasound of the heel bone are being studied. Nonetheless, awareness and prevention of osteoporosis are critical to the long-term health of our youngsters. An active lifestyle promotes additional cardiovascular, pulmonary, metabolic and muscular benefits. No child should be allowed to become child to be a couch potato. To this end, television time should be severely restricted and computer and electronic game time should be closely regulated.

*note that trampolines are not recommended for leisure use due to the high incidence of serious injuries. Trampolines should be used only in a setting with a coach and a spotter. The rails must be padded. Participants must be limited to one person at a time. No flips should be performed.

Dr. Mark B. Levin

Dr. Levin was a member of the staff at The Pediatric Group starting in 1977. He was an attending Pediatrician at the Medical Center at Princeton, Chairman, Department of Pediatrics, Medical Center at Princeton, 1984 to 1986, 1989 to 1992, and past President, Medical and Dental Staff, Medical Center at Princeton, 1987 to 1988. Dr. Levin served on numerous Departmental and hospital committees. He published original articles both while at Upstate Medical Center in Syracuse and at The Pediatric Group.

Dr. Louis J. Tesoro

Dr. Tesoro has been a member of the staff at The Pediatric Group since 1988. Dr. Tesoro is Attending Pediatrician, Medical Center at Princeton, 1988 to present. He has served on several Departmental and hospital committees and was Chairman, Department of Pediatrics, Medical Center at Princeton from 1996 - 2000. He has lectured at the Universiy of Pennsylvania and has published original articles both while at The Children's Hospital of Philadelphia and at The Pediatric Group.