Soft Bones are a Hard Problem for Kids

Pediatric bone health issues

/ Author:  / Reviewed by: Robert Carlson, M.D

Have you ever heard of a child having soft bones? It's what happens when their bones grow up without the things they need to get strong and support them throughout their lives.

Most people start worrying about bone health in their 50s and 60s, when osteoporosis becomes more common. But the younger years can also bring bone issues.

Soft, or weak bones might be to blame if a child breaks bones more easily than most children, or if they're not growing properly. Knock-knees and bow legs, generally assumed to be a thing of the past, are still a real problem.

Even if weak bones aren't a pressing health issue for your child, it's still important to make sure they are getting plenty of exercise, vitamin D, and calcium to build strong bones.

“It's important for children to have healthy bones, because when you build up stronger bones as a child, you're less likely to have problems as an adult,” says Dr. Ellen Raney. Dr. Raney is a children's orthopedic specialist at Shriner's Hospital for Children in Portland, Oregon.

She spoke with DailyRx News about some common pediatric bone health issues.

dailyRx: We tend to think of bone health as an issue that older adults deal with, not kids. Can you explain why this might be a misconception?

Dr. Raney: You can only build up your bones and make your bones stronger for first couple of decades of your life.

In your early twenties, your bones are strong as they're ever going to be. Then we try to keep them getting weaker too fast as we get older.

An adult woman with osteoporosis can't make their bones much stronger. It's all a matter of how strong you made them when you were a kid or early adult.

I always tell children it's like money in the bank. Imagine a bank account you can only put money into for the first twenty years, and you try not to take it out too fast.

Or, it's like a piggy bank and you try to make it full in the first twenty years, because you have take pennies out and you can never put them back in again.

So it's like the retirement fund for your bones?


What are the most common conditions that affect children?

If the bones are too soft they don't grow straight, if you're very young.

Some kids can grow severely stunted, or their arms or legs grow crooked. The bones can also easily be broken.

When might you start experiencing problems?

We see people with broken bones even in childhood. But with most people we start to see problems breaking your bones as early as your 40s or 50s. That is, if your bones are strong enough that you get there without thinking there's anything wrong.

We see children now whose bones are so soft they're symptomatic even as children.

Is this a new phenomena?

Actually, it was a big push in the 1920s and 30s, when everyone people were taking cod liver oil. They figured out that vitamin D was in cod liver oil. And then they started putting out supplements.

Rickets is the name for child when you have soft bones. We thought we wiped out rickets in the 1960s. And now we're seeing a resurgence.

Why do you think that is?

There's a lot of reasons – but we think that the two most important reasons are lack of getting out and exercising. People aren't exercising or playing all day, and they're not in the sun.

We're also seeing a problem with the big onset of obesity, and obviously the two are tied to together.

When you say a child has soft bones, what do you mean?

Kids who when they're still growing and walking legs start to grow crooked. You might see a child develop severe knock knee or severe bowing of the legs.

Or they can be extremely short. They start to sustain broken bones, when you wouldn't expect to, like when they have a minor fall.

So more like an osteoporosis fracture, when a brief topple can break your bones?

If you're an adult and you've had strong bones and they're getting weaker, that's osteoporosis. If you're a kid, and your bones are still haven't been made stronger, it's called osteomalcia.

Or it could be called rickets if the cause is not getting enough vitamin D or calcium.

How does it affect childrens' daily lives and development?

They can have a lot of pain. From a child's perspective, that would be what bothers them. Parents can say they're not growing normally, but a child only complains if something hurts.

What action can people take if they notice symptoms of poor bone health?

The best thing is to prevent it. The best thing is to get exercise, have your kids outside running around, not sitting in front of TV set all day.

Also, there's recommendations that we all receive enough vitamin D. this is from both the American Academy of Pediatrics and the Institute of Medicine. They recommend that for infants, they get 400 international units (iu) of vitamin D every day. For everyone over the age of 1, they should get 600 iu of vitamin D every day.

It's really hard to get through your diet, so that's why we sometimes recommend supplements. You can also make vitamin D if you're out of the sun, from a substance in your skin.

But dermatologists recommend we don't spend too much time in the sun because of damage to your skin. So if you're not going to go out in sunshine, it's recommended to take supplements.

Is there a treatment for rickets?

Treatment is primarily to get a bunch of vitamin D. If you had rickets that were symptomatic, you would get a prescription that's even more than the basic recommendation that I gave you.

Is it too late for you to have healthy bones as an adult?

It's never too late. You can always make the bones stronger until your mid-20s. You need your calcium as well as your vitamin D. You can make bones stronger by getting exercise, vitamin D, and calcium.

But even if your bones were weak after that time, you'd use the same recipe: vitamin D, calcium, and exercise, to keep from losing your bone strength too fast.  

Review Date: 
October 18, 2012