Effective counseling for children's bone health

Abstract

Poor bone health is a significant contributing factor to the frequency and severity of many childhood injuries and fractures. Osteoporosis starts in childhood. Therefore, it is important to optimize bone health in children in order to decrease the risk of injury, improve healing, and maximize peak bone mass. To do this, pediatricians and pediatric orthopedists need to effectively counsel patients and families to give them the tools necessary to effect lasting change. Bone health is a recipe that requires ingredients including calcium, vitamin D, vitamin C, vitamin K, and physical exercise. Required amounts of each component change as children grow and are lifelong requirements. Unfortunately, at this time, there is no uniform consensus on vitamin D supplementation guidelines or optimal serum levels. Current vitamin D dosing guidelines are age-based, but vitamin D is stored in adipose tissue and higher weights/body mass index (BMI) require higher doses of vitamin D to achieve and maintain adequate serum levels. Routine monitoring of vitamin D is recommended in all patients. However, re-evaluating the dosing guidelines to base them on weight/BMI, rather than age, should be considered.

Key concepts: (1)Bone health needs to be prioritized from a young age because the majority of peak bone mass is attained by the end of the second decade of life.(2)Patient counseling and patient buy-in are imperative to create lasting impact.(3)Bone health is a recipe and the amounts of ingredients needed will vary according to growth and body size.(4)Vitamin D dosing should take weight and body mass into consideration to achieve optimal serum levels.

Keywords: Bone health; Patient counseling; Pediatric; Supplementation regimen; Vitamin D.

Figure 1

Example of bone health recipe card.

Figure 2

When discussing serum 25(OH)D levels in this paper, ng/mL is used throughout. These images use nmol/L, which is equivalent to ng/mL multiplied by 2.5. Images adapted from open access article Ekwaru et al. .

Figure 3

37th-degree latitude division in the United States. Image created by C. Spingarn.