Bone health in children

 

Bone play many important roles in our body. They, along with the joints and muscles, provide shape, form, support, stability and movements to our body. They form a framework for growing body of a child. They protect our delicate organs like brain, spinal cord, heart, lungs etc. They also serve as the store house of the minerals calcium and phosphorus, that help them keep strong. The marrow. present in the bones produces the blood I cells- red cell, white cells, platelets etc. As such, it is essential to take due care of their health. Poor bone health, i.e. osteoporosis, is a major and a serious health problem worldwide as fractures of spine, hips and wrist bones occur just with a minor trauma.

Childhood and adolescence is the critical period for bone building. Lots of changes take place, including the bones model and remodel in order to acquire the adult configuration. New bone is formed and at the same time old bone is resorbed. Much more bone is formed than resorbed during childhood and adolescence, as the skeleton is growing both in size and density. Most Of our peak bone mass is formed during childhood and teenage. Having strong bones in childhood is beneficial in the later stages of life when we have more of bone loss and minimal or no bone formation. It won't be wrong to say that senile osteoporosis, old age weakness of bones, begins as a pediatric disease, i. e. roots are laid in childhood. Bone health in adults is dependent on the maximising bone mass during the critical periods of growth and development, i. e.  in childhood and adolescence. Children with strong bones have a better chance of avoiding bone weakness in the later stages of life, so it is important that due attention is given to bone health in children and the teenagers. In fact, it should start when a baby is in the womb of the mother as a healthy mother means a healthy baby. 

What has to be done to have an optimum bone health in children 

i) Regular physical activity has a lot of benefits on overall health of a person including that of bones. Bone is a living tissue, it responds to exercise by becoming stronger. Research has shown that bones become stronger and thicker with loading. The physical stimuli of loading weight bearing exercises, pressure, push and pull movements stimulate the bone cell to form new bone, increase bone mass and make the bones stronger. Physical activity positively affects bone health, while reductions in physical activity can result in bone loss. As most of the bone mass is laid down before adolescence, it is important that regular physical activity is started earlier in childhood and adolescence. Research has shown that a modest increase in weight bearing physical activity significantly improves bone density and strength in children and adolescents. Unfortunately most of us, including children, stay indoors playing games on computers, smart phones, watching television etc. and hardly spend any time in outdoor games and physical activities. This affects bone health. Insufficient physical activity eads to weakness of bones, osteoporosis and other medical problems. As such,children and the teenagers should regularly participate in the physical activity, outdoor games and sports activities, and spend less time on mobile phones, computers, TV and other gadgets. In fact, we should have a certain time limit for sedentary activities such as computers, television and smartphones. Parents and teachers have a big role in making this happen. Regular physical activity, especially started in childhood and adolescence is a cheap and safe way of improving bone strength. Simple walking, running, jogging, jumping, stair climbing, dancing, skipping and playing outdoor games are some of the weight-bearing exercises which a child can easily do. Exercise has to be regular and has to be of sufficient duration and intensity. Anything we can do to get our child moving will benefit growing bones of the child. Yes, we have to change the lifestyle from an unhealthy sedentary one to a more active one.

Yoga has a positive effect on the physical, mental and spiritual well being of a person. Yoga strengthens muscles, bones and the whole body. Best thing about yoga is that it is doable, effective, safe and does not involve much of expenses. Children have to be encouraged to do yoga and it should be done under the guidance of an expert.

ii) Balanced dietrich in calcium, vitamins especially D, C, K, proteins and magnesium is essential. Malnutrition, even though things have improved, is still a problem in children especially in developing countries in spite of many programmes started by the governments and other agencies. This does affect overall health of the children including that of bones. We somehow need to tackle it proactively with the involvement of the local society.

Calcium is the essential mineral for the bones. Children and adolescents need much more calcium than an adult as bones are developing and growing. Milk and dairy products like yoghurt, cheese etc. are rich in calcium and high in calcium absorption, thus are useful foods for maintaining bone health. In addition green leafy vegetables like broccoli, turnip greens, mustard greens, dried figs and nuts like almonds also provide calcium. Somehow or other the children and the teenagers of the present times are averse to consuming milk and milk products and one of the reasons. for that is the misconception that milk makes you fat. We need to reverse this trend and encourage children to drink more milk. We also need to discourage children from taking junk food, soda and cola as they contain considerable amounts of phosphoric acid and caffeine which drain calcium from bones. Routine calcium supplementation as such should not be recommended to normal children and adolescents. It is better to encourage them to consume more milk, fresh green vegetables and fruits that are important dietary sources of calcium. It is of utmost importance that children get into good- healthy eating habits and in this parents can set an example.

Vitamin D is important for calcium absorption and mineralization of bone. Exposure to sunlight provides vitamin D by way of skin, however most of us. including children staying indoors playing games on computers, smart phones etc. So most of us are not able to make use of this free sources of vitamin D. As it is, there is deficiency of vitamin D in children, so we should supplement them.

iii) Low Body weight is associated with low bone mass. Studies have shown a close connection between osteoporosis and low body weight. Nowadays as we all see, there is a general trend in people especially in teenagers - more so in females to be extra slim. This, as it is, is not good for bone health. A low body weight and low muscle mass result in less stimulation of the bones and hence lower bone mass. On the contrary obesity is also not good for overall health including that of bones. As such, it is important that children have an optimal body weight.

iv) Smoking and alcohol consumption have to avoided as they are associated with low bone mass. Both are very harmful for bones. Both damage the bone cells and have negative influence on bone density.

v) Education of children, parents, teachers and public in general about bone health, its importance in children and what all can be done to maintain it is important. We have to have an action plan for maintaining bone health in children as best of our peak bone mass is formed during childhood and teenage. In fact physical activities and yoga should be made

important part of the curriculum in schools and due weight should be given to it so that children take them seriously. Children, being the future of the nation, it is all the more important that due attention is given to their health that includes bone health also.

Having discussed what all can be done to improve and maintain bone health, we have to keep in mind that there are some factors like genetics and heredity, upon which we do not have much of control. Genetics doesplay an important role in the development of peak bone mass and it has been reported that about 70% of an individual's peak bone mass is influenced by genetics. Effects of genetics and heredity do manifest in childhood prior to puberty. Good thing is that a lot of research is going on and there has been some progress in identifying the genes responsible for peak bone mass, however, a lot more has to be done to know the specific gene responsible for peak bone mass and osteoporosis.

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Courtesy:  Dr. M.K. Mam   and  Koshur Samachar 2022, April