Understanding Adolescent Osteoporosis: A Growing Concern Among Youth

The Rising Issue of Osteoporosis in Young People

Mayank, a 17-year-old, was engrossed in his studies for engineering entrance exams. His extended hours of sitting led him to snack on chips and soft drinks, often replacing his regular meals with these unhealthy choices.

He frequently experienced back pain, discomfort in his limbs, and fatigue, despite not engaging in any physical activities. After two years on anti-epileptic medication, he visited my clinic, where X-rays and a DEXA scan indicated he was suffering from adolescent osteoporosis. This condition stemmed from several risk factors, including poor nutrition, vitamin D deficiency, limited sun exposure, inadequate calcium intake, and a lack of physical activity.

To address his condition, he was advised to take calcium and vitamin D supplements, engage in regular exercise, and maintain a balanced diet. Additionally, it was recommended that he consult his doctor about possibly changing his epilepsy medication.

Traditionally, osteoporosis is associated with older adults, particularly postmenopausal women due to decreased estrogen levels and men over 60 due to lower testosterone levels. This disease is characterized by diminished bone mass, which increases the risk of fractures.

Factors such as inadequate nutrition from childhood, the replacement of traditional Indian diets with junk food, reduced sun exposure, low calcium intake, and a sedentary lifestyle are contributing to the early onset of osteopenia and osteoporosis among adolescents and young adults.

A recent case in Pune highlighted this issue when an 11-year-old boy was diagnosed with osteopenia after suffering a femur fracture from a minor fall. Contributing factors included poor dietary calcium intake, limited sun exposure, and insufficient physical activity.

During adolescence and young adulthood, nearly 90% of peak bone mass is achieved, which is crucial for lifelong skeletal health.

A diet rich in calcium and protein, along with regular exercise and adequate vitamin D from sun exposure, stimulates bone-forming cells known as osteoblasts. Conversely, a sedentary lifestyle, increased junk food consumption, smoking, alcohol use, and certain chronic diseases can suppress osteoblast activity and promote bone resorption, leading to osteoporosis.

A calcium and protein-rich diet, exercise, and adequate vitamin D are essential for stimulating osteoblasts, while a sedentary lifestyle and junk food consumption can lead to osteoporosis.

Initial signs of osteoporosis can be subtle, including fatigue, intermittent back pain, and discomfort in extremities. Persistent pain may indicate micro-fractures in the vertebrae due to weakened bones. If left untreated, even minor trauma can result in serious fractures.

Given that osteoporosis can be asymptomatic until a fracture occurs, young individuals should be vigilant about these subtle signs, especially if they are on long-term medication or have poor lifestyle habits. Early detection and lifestyle modifications can significantly mitigate the disease.

Diagnosis typically involves assessing symptoms alongside blood tests for calcium, phosphate, alkaline phosphatase, parathyroid hormone (PTH), and vitamin D levels, as well as X-rays and DEXA scans.

Management focuses on addressing the underlying causes and implementing lifestyle changes.

For those with vitamin D and calcium deficiencies, a daily intake of 1000–1200 mg of calcium and 800–1000 IU of vitamin D is recommended. If vitamin D levels are low, loading doses may be necessary.

Daily exposure to sunlight for about 30 minutes, covering 30% of bare skin (like arms and legs), is crucial for adequate vitamin D synthesis. Foods such as milk, dairy products, leafy greens, eggs, legumes, fruits, and nuts should be included in the diet, while junk foods high in phosphates and sugars should be avoided.

Engaging in 30-40 minutes of exercise at least 5-6 days a week, including weight-bearing and resistance training, is vital for stimulating bone formation and strengthening muscles.

Balancing study or work commitments with physical activity, along with ensuring proper rest and sleep, is essential.

Individuals on medications that may contribute to osteoporosis should consult their healthcare provider about alternatives that have a lesser impact on bone health.

Prevention and Awareness

Preventing osteoporosis should begin early, during childhood and adolescence, which is critical for peak bone mass development. Health education in schools and colleges should stress the importance of balanced nutrition, regular exercise, and the dangers of smoking and alcohol, along with safe medication practices and awareness of drug side effects.

— The writer is Chairman, Orthopaedics, Joint Replacement and Sports Injuries, Paras Hospital, Panchkula

Poor nutrition, junk food consumption, vitamin D deficiency, and a sedentary lifestyle are leading to early osteopenia and osteoporosis.

Potential Causes of Osteoporosis

Steroids: Prednisolone, Dexamethasone, Methylprednisolone

Anti-epileptic drugs (AEDs): Phenytoin, Phenobarbital, Carbamazepine, Valproate

Antacid drugs: Omeprazole, Pantoprazole, Esomeprazole

Drugs affecting the central nervous system: Fluoxetine, Sertraline, Paroxetine

Anti-cancer drugs: Methotrexate, Cyclophosphamide

Anti-HIV Drugs: Tenofovir, Zidovudine

Long-term Anti-coagulants: Heparin, Warfarin

Hormonal medications: Levothyroxine, Leuprolide, Goserelin, Flutamide, Letrozole, Anastrozole

Diuretics: Furosemide

Immunosuppressants: Cyclosporine, Tacrolimus

Substance use: Alcohol, smoking

Chronic diseases that increase osteoporosis risk

— Cushing’s syndrome, hyperthyroidism, hyperparathyroidism, diabetes mellitus, hypogonadism

— Celiac disease/malabsorption syndromes, Crohn’s disease/ulcerative colitis, chronic liver disease

— Chronic kidney disease (CKD)

— Rheumatoid arthritis, systemic lupus erythematosus (SLE)

— Cerebral palsy/spinal cord injury

— Thalassemia major, multiple myeloma

— Chronic obstructive pulmonary disease (COPD)

— Anorexia nervosa/malnutrition

— AIDS

— Chronic immobilization (bedridden state, paralysis)

— Organ transplantation (post-transplant bone disease)

Factcheck

Research indicates that osteoporosis is becoming more prevalent among individuals in their 30s in India, although it remains less common than in older populations. A study published in a Science Direct journal reported a 3% prevalence of osteoporosis in women and 0% in men within the 30-39 age group at the lumbar spine. Another review from the National Institutes of Health found that approximately 8.5% of women in this age range had osteoporosis, while 45.7% had osteopenia.