Building Strong Bones in Kids

Why Osteoporosis Prevention Should Start in Childhood

 

Most people don’t think we need to worry about osteoporosis until “middle age.” I certainly didn’t worry about my kids’ bones – until my 7 year old got a buckle fracture on her arm this past spring from a fall onto grass in the backyard. It didn’t seem like a hard fall, and I wondered – could she be missing some critical bone-building nutrients? The doctor said her bones looked fine on the X-Ray, and he didn’t think a scan was necessary – so I decided to research dietary ways of boosting bone strength. An article in Parents magazine, The Broken Bone Epidemic says that more kids could be missing important bone-building nutrients, potentially one reason why there has been a steady rise in bone fractures. A Mayo Clinic study published in JAMA, found that compared to 30 years ago – forearm fractures had risen more than 32% in boys, and 56% in girls. According to the study, forearm fractures in children could be a predictor for hip and other serious fractures in late adulthood. Understanding and addressing ways to boost kids’ bone health might not only prevent bone fractures now, but it could also prevent or delay the onset of osteoporosis later in life. Read about the functions of bonesfrom the International Osteoporosis Foundation.

 

Broken Bone – Bad Fall or Warning Sign?

An unfortunate side effect of many sports, trampolines, playground activities – a broken bone can simply be the result of a forceful impact. But in some cases it can be a warning sign of a dietary deficiency. Nutrient deficiencies can result from dietary inadequacy, impaired absorption or use, increased requirement, or increased excretion. If your child has broken a bone – don’t panic – it may be that their bone development is right on track and they simply had a really hard fall. But if your child has suffered repeated brakes, on-going bone or muscle pain, or bones fracturing from seemingly “minor impact” – it might be worth a trip to the pediatrician. Your child’s doctor can decide if a bone scan and/or an assessment of their dietary calcium, or a screen for Vitamin D levels is needed. Another issue could be hypercalcuria – which is elevated calcium in the urine.According to The International Osteoporosis Foundation, “peak bone mass” is reached before age 25. This means that critical bone-building occurs before the age of 20 or 25 – so teens that are facing critically low bone density levels, don’t have many years left to build them up. There are many factors that go into building strong bones, and missing one or more could add up to trouble.

 

Calcium:
Kids today are consuming more sports drinks, juice boxes and sodas than ever before, and less calcium rich foods and drinks. Picky eating is also becoming more prevalent. So its no surprise that kids might not be getting enough dietary calcium needed to build strong bones and teeth. Milk and other dairy products like cheese are excellent sources of calcium, but there are some potential downsides to getting our calcium from dairy products (read Got Fractures?). Fortunately there are excellent non-dairy sources of calcium – with dark green vegetables topping the list. Spinach has a high calcium content, but it also contains oxilates – which binds to the calcium therefore limiting much of the calcium absorption.  An excellent source of vitamin K, spinach still contributes to a healthy bone diet. There are also a plethora of milk substitutes now – such as coconut, hemp, and almond milk – most of which are fortified with calcium and vitamin D. See this chart of calcium-rich foods. Kids who are 1-3 years old require 500 mg. a day of calcium. As kids grow, their calcium requirements grow too. At around age 11, kids need anywhere from 1,200 – 1,500 mg. of daily calcium. Yet while their calcium requirements have risen, unfortunately so has the consumption of sports drinks and sodas. This is a perfect example of why it is important to instill good eating habits as early as possible. The older a kid gets, the more set their dietary habits are and therefore more difficult to change – yet their bodies needs for nutrients are much higher. The more independence they have – means they will be making more of their own choices of what to eat and drink. Kids that have already developed good habits early on, such as reaching for fruits and vegetables – naturally are going to reach for healthier choices when they are on their own.Use this calcium calculator to find out how much dietary calcium is needed.

 

Calcium’s Key Partners

Calcium is just part of the bone-building picture. There are other key nutrients that work synergistically with calcium, of primary importance for bone-building are vitamin D, vitamin K, and magnesium. If a child is deficient in one or more of these, they could have issues with their bone density and/or strength. In fact, taking calcium without sufficient vitamin D or K to help with absorption can cause calcifications in areas they are not wanted – like the arteries of the heart. That is why too much calcium that is not properly absorbed can increase the risk of heart disease, and kidney stones.
 
Vitamin D:

Vitamin D is not really a vitamin, but a pre-hormone produced in the skin after exposure to the sun’s UVB rays. Very few foods in nature contain significant amounts of natural vitamin D – fatty fish (with wild salmon at the top of the list) and fish liver oils contain it. The majority of dietary vitamin D comes from foods that are fortified with vitamin D – such as milk. The best source by far is the sun, which is why vitamin D is called the “Sunshine Vitamin”. Vitamin D is critical for calcium absorption – which is why low levels can be associated with rickets and osteoporosis.For years doctors and dermatologists have been telling us to protect our skin from the sun, so we have dutifully slathered sunscreen on our kids. But what doctors did not tell us is that by doing this, is that we need to be careful to obtain our vitamin D from other sources. A study published in 2009 in the Archives of Internal Medicine, found that 70% – 97% of Americans have insufficient blood levels of Vitamin D – a contributing factor to osteoporosis, linked to a recent rise in bone fractures, and even linked to several different types of cancers. So even if your child is getting plenty of calcium, there needs to be enough vitamin D to aid in the absorption. The recommended daily intake of vitamin D for kids is 600 IUs, but there is much debate about whether or not that is enough to maintain serum blood levels. Just 15 mins in the sun a few days a week might be enough to enable our bodies to manufacture enough vitamin D (the amount of time needed depends on the pigment of skin). But even people who spend hours in the sun can be deficient – like swimmers and surfers. The reason why – is that vitamin D can actually wash off the skin before it is fully absorbed!

In a study involving 150 children and adults with unexplained muscle and bone pain, almost all were found to be vitamin D deficient; many were severely deficient with extremely low levels of vitamin D in their bodies. A few years ago, Gwyneth Paltrow fractured her tibia, which led her doctors to discover that she had osteopenia – early stage osteoporosis. Gwyneth’s vitamin D levels were found to be dangerously low. Unfortunately they did not catch it before her tibia broke, but it was discovered in time to prevent further bone loss, and potentially worse – low levels of Vitamin D are linked to cancer. Visit her blog “Goop” to read more about her fractured tibia and vitamin D. If you suspect that your child might have low vitamin D levels, a simple blood test can find out. Read “Am I Vitamin D Deficient?” from the Vitamin D Council for more information. According to the Vitamin D Council, “although many doctors are still prescribing vitamin D2, vitamin D3 (cholecalciferol) is the preferred form for treating deficiency and is what is recommended by the majority of the experts.”

Vitamin K:
Vitamin K is one of the key nutrients for keeping our blood clotting ability at the exact right level – both enabling clots by stopping blood from flowing from a wound, and preventing blood clots in the vessels. In addition to clotting, vitamin K plays a key role in making sure calcium gets to the bones. This helps to build healthy bones, and at the same time prevent calcifications in other areas of the body – such as our arteries, to prevent “hardening of the arteries.” Vitamin K helps to make sure our bones maintain a healthy balance of minerals and proteins. Our bodies can obtain vitamin K from plant foods – such as spinach, Brussels sprouts, green beans, asparagus, broccoli, kale and mustard greens. Studies have shown that individuals that consume sufficient amounts of vitamin K have fewer fractures. People who are anemic, or have trouble with bleeding gums or heavy periods could have a deficiency in vitamin K. Our bodies also manufacture vitamin K from the bacteria in our guts. So any disorder that impacts the digestion could also mean a deficiency in vitamin K – such as celiac, IBS, and other disorders of the digestive tract. Digestion disorders and food sensitivities and allergies are becoming increasingly common – so more and more people are developing deficiencies. * Learn more about Vitamin K.

Magnesium:
The fourth most abundant mineral in the body, magnesium comprises about 1% of bone mineral. It plays a key role in how the body converts food into energy, bone health, nerve functions, and even helps to regulate blood pressure. All the enzymes that metabolize vitamin D require magnesium to work. So even if you are supplementing with high levels of vitamin D, without sufficient magnesium, it might not be properly absorbed. Good food sources of magnesium are nuts, seeds, whole grains, dried fruit, and some fish. Like many other minerals, magnesium has been consistently depleted from our soils, so levels in food can vary depending on the quality of soil it came from. Taking magnesium with calcium helps to counteract the constipating effects of calcium.  Traditionally the recommended ratio of calcium to magnesium is 2:1. But many people find that a ratio of 3:2 works best for them, especially athletes – magnesium is excreted when we sweat – so people who work out and exercise a lot – might have higher needs to magnesium. If someone experiences loose stools however, the magnesium levels might need to be lowered.  If someone is taking too high levels of calcium, magnesium absorption can be blocked. Salt, sugar, caffeine and stress can also deplete our magnesium. The daily recommended requirement of magnesium for children varies with age and gender. Infants under six months of age only need 30 mg, obtained from breast milk or formula. Toddlers need around 80 milligrams per day; which can be attained from a cup of yogurt (45 mg.) and 2 tablespoons of nut butter (50 mg.). Children from four to eight years need 130 mg. From the age of nine to thirteen, the daily amount of magnesium jumps to 240 mg. During the teenage years, girls need 360 mg, while boys require 410 mg. Leg pain, foot or eye twitches, muscle cramps, irritability and even sensitivity to light can all be signs of a magnesium deficiency. If allowed to progress, migraines, insomnia, chronic fatigue syndrome, and even kidney stones can develop.

Exercise:
The old adage “use it or lose it” that goes for our muscles – also applies to our bones. Exercise is very important for our bone health – especially the weight-bearing kind. When we lift weights, or stress our muscles, they get broken down, and then rebuild themselves – stronger. This is similar with our bones. Weight bearing activities that apply a “force” on our bones are important for building strong bones. The need for weight bearing activities can be well-illustrated by astronauts – spending 6 months without gravity can cause them to lose up to 30% of their bone strength.

There are more reasons than ever for kids to sit still – homework, TV, video or computer games, and phone texting. Exercise with impact is very important for building bones. Kids need to be running, jumping rope, playing tag, doing gymnastics, and other sports that require impact. Although better than sitting – scootering around the cul-de-sac does not count for bone-building, as there should be force exerted on their bodies and bones, which causes the bones to be stronger. But we want to be careful here – if you suspect your child might have deficiencies – too much stress can result in a break or a fracture. So we want to make sure our bones are in good health first.

Bone-Building Foes

Sugar & Salt:
Further complicating matters could be a diet that is high in salt or sugar. If consumed in excess, salt causes us to excrete more calcium, depleting it from our bodies. Sugary foods cause the body to not absorb calcium as well – especially sodas. The American Journal of Clinical Nutrition found that daily soda consumption was linked to lower bone density. Sodas give us a double-whammy against bones – the sugar and the phosphoric acid. Phosphorus itself is an important bone mineral. But if you’re drinking a lot of soda, you could be getting a disproportionate amount of phosphorus compared to the amount of calcium you’re getting, and that could lead to bone loss. Not all sugars are created equal – lactose which is the naturally occurring sugar in milk – actually enhances calcium absorption. However, it is estimated that because less than half the population actually is able to completely digest lactose – they could be suffering from inflammation, which interferes with absorption of minerals and vitamins. Agave nectar is a better sweetener alternative than sugar, because it naturally contains inulin fructans, which also enhances the absorption of calicum, and potentially even magnesium.

Digestive Disorders:
Untreated celiac disease can increase your risk of osteoporosis. Celiac disease occurs when someone is not able to tolerate the gluten found in wheat and other foods. Consuming gluten can create serious and debilitating inflammation and “leaks” in the intestinal lining of someone with celiac – which can result in low absorption of many nutrients, including important bone-building blocks like vitamin K, and vitamin D. Celiac disease used to be a rare condition, but it is much more common now – affecting as many as 1 in 33 people by some estimations. And even if a person does not have a full blown allergy to gluten, they can be “sensitive” to it – overtime this can lead to chronic gut inflammation which can limit the proper absorption of nutrients. Other disorders of the digestive tract can also cause malabsorption issues – such as IBS, Crohns, and more.

Picky Eating:
Kids whose daily diet contains dark green vegetables like kale and broccoli, calcium sources, nuts or seeds, along with exercise, and a short amount of time in the sun, are probably going to be right on track for bone-building. But if you have a picky eater, you probably are worrying that your kid is not getting the right nutrients, including the ones needed to build strong bones.  You are not alone, most households have at least one picky eater nowadays. Don’t give up on them, most kids can expand their palate if given time and encouragement (and not allowed to “snack” and eat treats all day long). The younger you can start, the better.  Read 20 Tips for Picky Eaters for more ideas.

Taking a high quality well-balanced multi-vitamin is a nice safeguard against dietary imbalances, ideally one that is whole-foods based.  I like Animal Parade multivitamins or Rainbow Light products, both brands use high quality ingredients, no artificial colors, and they also contains foods and herbs. As far as calcium supplements, I recommend and use AlgaeCal, which is an algae-based calcium supplement that contains the co-factors needed for proper absorption.  When using supplements, follow the dosing directions on the label or from your doctor – as the fat soluble vitamins are not readily excreted like the water-soluble vitamins and can accumulate in the body if too many are taken.  Unabsorbed calcium can end up in places it is not wanted too – like the arteries of the heart, or as kidney stones. Realize that most multi-vitamins do not contain all the vitamins and minerals that kids need every day, some are missing several key nutrients. So even the highest quality multi-vitamin or supplement is not a replacement for a balanced diet – vitamins and minerals obtained from foods work together synergistically and are better absorbed.  A well-balanced diet boosts the immune system, improves energy, mood, and digestion – so the benefits extend way beyond the bones.

If you are worried that something could be amiss – such as unexplained bone or muscle pain, poor healing bones, or repeated fractures, the pediatrician can run a simple blood test to check for vitamin D levels, and a screening for celiac disease.  If bone pain or a broken bone does turn out to be related to a deficiency – the sooner it is discovered the better – while there is still time to make the diet/lifestyle changes needed to help build strong bones to last a lifetime. Because Vitamin D deficiencies have been linked to many types of cancer, it is even more important to identify deficiencies as early as possible.

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Article by Sara Vance, a Clinical Nutritionist in the Encinitas, CA area. Sara specializes in kids & family nutrition, picky eaters, cancer prevention, weight loss, and more. Sara knows how hard it is to make healthy choices – she was a picky eater and overweight as a child, and is passionate about sharing her knowledge with others. She has a picky eater in her family – who broke her arm this past Spring – which led Sara to examine this issue and put together this article.

Sara offers nutritional counseling, School Assemblies, group classes, kids healthy cooking, and more. If you are not in the CA area – Sara also offers Skype and telephone counseling. Visit ReBalanceLife for more information.

©2011, all rights reserved. Sara Vance.  (Note – this article was edited in Oct, 2012)

Research Links:

Incidence of Childhood Distal Forearm Fractures Over 30 Years. 2003, JAMA
Healthy Children with Frequent Fractures, How Much Evaluation is Needed? Published May 1, 2008 – the Official Journal of the American Academy of Pediatrics.

*This content is not to be construed as providing medical advice. All information provided is general and not specific to individuals. Persons experiencing problems or with questions about their health or medications, should consult their medical professional. Persons already taking prescription medications should consult a doctor before taking the above foods, herbs, vitamins or supplements to be sure there are no interactions.

4 Responses so far.

  1. [...] cause constipation, and even lead to other problems like low bone strength and density (read Building Strong Bones in Kids). The younger you can start, the better, because as kids get older – their eating habits get [...]

  2. [...] healthy bones, as many kids (especially teenagers) are not getting enough calcium each day.  Read Build Strong Bones in Kids to learn more about calcium and other nutrients kids need to build healthy [...]

  3. [...] – like the arteries of the heart, leading to hardening of the arteries.  Read more about vitamin D’s role in calcium absorption.  Low levels of vitamin D have also been linked to heart disease, some cancers, diabetes, immune [...]

  4. [...] Other factors can interfere with bone building such as taking steroid medications for an extended period.  A visit to the doctor might be prudent if there have been frequent/recurring breaks, unexplained bone pain, fractures from minor impacts, and poor slow growth. Contact your doctor or pediatrician with any concerns.  Read Kids and Broken Bones – When Is it a Warning SIgn? and Building Strong Bones in Kids. [...]