Prevention of osteoporosis in children

In the literature there is information about the relationship between the prevention of osteoporosis in adults and the accumulation of bone mass in childhood. The authors argue that if the mineral weight of bone in childhood was reduced by 5-10%, then in old age the frequency of hip fracture increases by 25-30%. The literature cites data on the direct dependence of women's BMD on consumption in childhood and adolescence of foods rich in calcium, on the possibility of an increase in bone mass in adults by 5-10% due to the consumption of the age-related calcium in early childhood. According to foreign authors, this is enough for a twofold reduction in the risk of fractures in later life.

The most important physiological stage in the development of the skeleton, which determines the strength of bones throughout the life of a person, is the formation of peak bone mass. Its intensive accumulation occurs precisely in childhood, especially during puberty. It is suggested that osteoporosis is more often formed in cases when the bone mass does not get genetically determined magnitude.

Thus, the risk of development and severity of osteoporosis in adults during the physiological periods of life (pregnancy, lactation, aging), in case of possible diseases associated with a violation of calcium metabolism, will largely depend on the state of the bone mass of the growing organism.

The main measures for the prevention of osteoporosis and fractures in childhood, therefore, both in working age and in the elderly, include the provision of adequate nutrition. Adequate calcium intake is the most important factor for achieving optimal bone mass and size.

Optimum calcium intake in different periods of human life

Age and physiological periods of human life	Need for calcium, mg / day
Newborns and children under 6 months	400
1-5 years	600
6-10 years	800-1200
Adolescents and adults up to 24 years of age	1200-1500
Pregnant and lactating women	1200-1500
Women 25-50 years, men 25-65 years	1000
Postmenopausal women, men and women over 65 years of age	1500

However, if there is a violation of the processes of assimilation of calcium, its additional intake into the body will not lead to a significant increase in bone mass.

• Factors that improve calcium absorption in the intestine:
  • availability of vitamin D (400-500 IU / day), with its deficiency absorbed in 5-7 times less calcium;
  • the optimal ratio of calcium and phosphorus in the diet (2: 1);
  • optimal ratio of calcium and fat (0,04-0,08 g of calcium per 1 g of fat); with excess fat in the intestine, poorly soluble calcium soaps are formed, which are excreted with feces, contributing to loss of calcium.
• Alimentary factors that reduce calcium absorption in the intestine:
  • food fibers (in cereals, fruits, vegetables);
  • phosphates (in fish, meat);
  • Oxalates (in cocoa, chocolate, spinach, sorrel).

Calcium in basic foods

Product	Calcium content, g / 100 g	The amount of the product containing a daily rate of calcium
Milk, kefir 3.2%	120	650-1000 ml
Sour cream 10%	90	1000-1300 ml
Curd 9%	164	500-730 g
Hard cheese	1000	100-120 g
Beans	115-150	500-1200 g
Vegetables fruits	20-50	1500-6000 g
Milk chocolate	150-215	500g
Meat	10-20	4000-12 000 g
A fish	20-50	1500-6000 g
Bread	20-40	2000-6000 g

If it is impossible to meet the calcium needs of food, a healthy child should be prescribed a calcium supplement. More often, carbonate is used, more rarely calcium citrate, usually in combination with a physiological dose of vitamin D (400 IU). The physiology of calcium metabolism is such that its maximum excretion takes place at night. That is why it is advisable to take these medications in the evening, preferably while eating, thoroughly chewing.

The content of elemental calcium in its various salts

Salts of calcium	The content of elemental Ca in mg per 1 g of calcium salt
Carbonate	400
Chloride	270
Citrate	200
Glycerophosphate	191
Lactate	130
Gluconate	90

Prevention of osteoporosis must begin in the antenatal period, when there is an active calcium deposition in the fetal bone that forms, requiring the mobilization of calcium from the mother's body. In connection with this during pregnancy, the needs of women in calcium, as in protein, vitamins and other micronutrients, increase.

Preventive maintenance of osteoporosis in the postnatal period includes, first of all, the preservation of breastfeeding. Calcium in breast milk is contained in a relatively small amount (4 times less than in cow's milk). However, the ideal ratio of calcium and phosphorus in it, the presence of lactose, which creates the optimal pH of the intestine, ensure maximum bioavailability of mineral salts for the baby.

When organizing artificial feeding, only adapted breastmilk substitutes should be used, the ratio of calcium and phosphorus in which is close to their ratio in human milk and the vitamin D content provides a physiological need.

Rational introduction of complementary foods (from 4-6 months) is an important factor in the prevention of osteoporosis.

Another important component of prevention of osteoporosis in children is moderate exercise, and it is dynamic, when children move rather than static, when the child is forced to stand or lift heaviness for a long time. According to numerous studies, physical exercises for the prevention of osteoporosis in schoolchildren should include daily exercise and / or exercise for at least 60 minutes. The intensity of classes can have a moderate or more energetic character (group games with the ball, jumping rope, running, etc.).

Thus, rational nutrition, providing calcium, vitamin D, a complex of interchangeable and irreplaceable micronutrients, combined with moderate physical activity - effective measures for the prevention of osteoporosis in children.

Prevention of secondary osteoporosis in various diseases depends on many factors: the severity and duration of the pathological process, the nature of therapy, the age of the children. It is mandatory to consume daily calcium (food and / or drug) in combination with vitamin D in a preventive dose (400 IU).

When using glucocorticoid drugs with an expected duration of treatment of at least 2 months, regardless of the dose of the child, it is necessary to prescribe anti-osteoporotic medications at once for preventive purposes. At a daily dose of glucocorticosteroids no more than 0.5 mg / kg, the use of active metabolites of vitamin D in a dose of at least 0.25 μg / day is recommended. If the daily dose of glucocorticosteroids is at least 1 mg / kg, it is advisable to use calcitonin as an intranasal spray at a dose of 200 IU / day. A combination of these drugs is acceptable, which potentiates the effectiveness of each other.

[1], [2], [3], [4], [5], [6], [7],