Prevention of osteoporosis in children

The literature contains information on the relationship between the prevention of osteoporosis in adults and the accumulation of bone mass in childhood. The authors claim that if the mineral mass of the bone in childhood was reduced by 5-10%, then in old age the incidence of hip fracture increases by 25-30%. The literature provides data on the direct dependence of BMD in women on the consumption of calcium-rich foods in childhood and adolescence, on the possibility of increasing the peak bone mass in adults by 5-10% due to the consumption of age-appropriate calcium in early childhood. According to foreign authors, this is sufficient to halve the risk of fractures in later periods of life.

The most important physiological stage of skeletal development, which determines the strength of bones throughout a person's life, is the formation of peak bone mass. Its intensive accumulation occurs precisely in childhood, especially during puberty. It is assumed that osteoporosis is more often formed in cases where bone mass does not reach the genetically determined value.

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

The main measures for preventing osteoporosis and fractures in childhood, and therefore in working age and old age, include ensuring adequate nutrition. Adequate calcium intake is the most important factor for achieving optimal bone mass and size.

Optimal calcium intake at different periods of human life

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

However, if there are problems with calcium absorption processes, its additional intake into the body will not lead to a significant increase in bone mass.

• Factors that improve calcium absorption in the intestines:
  • provision of vitamin D (400-500 IU/day), when there is a deficiency, 5-7 times less calcium is absorbed;
  • optimal ratio of calcium and phosphorus in the diet (2:1);
  • optimal ratio of calcium and fat (0.04-0.08 g calcium per 1 g fat); with excess fat in the intestines, poorly soluble calcium soaps are formed, which are excreted in the feces, contributing to the loss of calcium.
• Alimentary factors that reduce calcium absorption in the intestine:
  • dietary fiber (in cereals, fruits, vegetables);
  • phosphates (in fish, meat);
  • oxalates (in cocoa, chocolate, spinach, sorrel).

Calcium content in staple foods

Product	Calcium content, g/100 g	The amount of product containing the daily requirement of calcium
Milk, kefir 3.2%	120	650-1000 ml
Sour cream 10%	90	1000-1300 ml
Cottage cheese 9%	164	500-730 g
Hard cheese	1000	100-120 g
Legumes	115-150	500-1200 g
Vegetables, fruits	20-50	1500-6000 g
Milk chocolate	150-215	500 g
Meat	10-20	4000-12000 g
Fish	20-50	1500-6000 g
Bread	20-40	2000-6000 g

If it is impossible to replenish calcium needs with food, a healthy child should be prescribed a calcium preparation. Most often, calcium carbonate is used, less often 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 occurs at night. That is why it is advisable to take these preparations in the evening, preferably during meals, chewing thoroughly.

The content of elemental calcium in its various salts

Calcium salts	Elemental Ca content in mg per 1 g of calcium salt
Carbonate	400
Chloride	270
Citrate	200
Glycerophosphate	191
Lactate	130
Gluconate	90

Prevention of osteoporosis should begin in the antenatal period, when calcium is actively deposited in the developing bone tissue of the fetus, requiring the mobilization of calcium from the mother's body. In this regard, during pregnancy, a woman's needs for calcium, as well as for protein, vitamins and other micronutrients, increase.

Prevention of osteoporosis in the postnatal period includes, first of all, maintaining 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 an optimal pH of the intestine, ensure maximum bioavailability of mineral salts for the baby.

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

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

Another important component of osteoporosis prevention in children is moderate physical activity, specifically dynamic, when children move, and not static, when a child is forced to stand for a long time or lift weights. According to numerous studies, physical activity for the prevention of osteoporosis in schoolchildren should include daily exercises and/or sports activities for at least 60 minutes. The intensity of the activities can be moderate or more vigorous (group ball games, jumping rope, running, etc.).

Thus, a balanced diet that provides calcium, vitamin D, a complex of replaceable and essential micronutrients, combined with moderate physical activity are 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 children. It is necessary to consume the daily norm of calcium (dietary and/or medicinal) in combination with vitamin D in a prophylactic dose (400 IU).

When using glucocorticoid drugs with an expected treatment duration of at least 2 months, regardless of the dose, the child should immediately be prescribed anti-osteoporotic drugs for prophylactic purposes. With a daily dose of glucocorticosteroids of no more than 0.5 mg / kg, it is recommended to use active metabolites of vitamin D at a dose of at least 0.25 mcg / day. If the daily dose of glucocorticosteroids is at least 1 mg / kg, it is advisable to use calcitonin in the form of an intranasal spray at a dose of 200 IU / day. A combination of these drugs is acceptable, which potentiate each other's effectiveness.

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