Orthopaedic surgery/Sports and rehabilitative medicine

Bone Health Program

What bone health means

Bone health is concerned with the growth and quality of a child's skeletal system (the bones); the condition of the bones is an important indicator of a child's development and potential for future health and wellness.

Bone health in children is important because bones grow throughout childhood, increasing not only in length but also in density. In fact, bone mass normally increases by 50 percent in adolescence. Bone mass typically peaks between the ages of 16 to 25 years, levels off and then goes through a gradual decline throughout adulthood.

If optimal bone mass is lacking, children and adolescents can develop juvenile osteoporosis, a potentially serious disease that results in an increased risk of fractures. Likewise, there is a greater risk for osteoporosis and fractures in adulthood.

Who needs a bone health evaluation?

Children who have recurring fractures in the long bones (such as the tibia — the “shinbone” — in the leg), or who have fractures that occur with only a minor injury
Children who have spinal deformities or loss of height
Children who must take inhaled or corticosteroids by mouth for long periods of time, or those who must take frequent “bursts” of corticosteroids by mouth or intravenously
Children who take certain medications to prevent seizures. These medications — phenobarbital, valproate, phenytoin and carbamazepine — appear to negatively affect bone density.
Children who take the birth control medication medroxyprogesterone. While medroxyprogesterone (the “shot”) is quite effective in adolescent females, recent data has shown that bone density can suffer from long-term use.
Children with chronic diseases that are linked with poor gastrointestinal absorption of the nutrients in food, such as irritable bowel syndrome and cystic fibrosis. These and other chronic illnesses can cause gastrointestinal inflammation and decreased absorption, putting children at risk for low bone density.
Children who are malnourished. For example, patients suffering from eating disorders are at risk due to their significant nutritional deficiencies. And obese patients are at risk for poor bone health especially if they have additional risk factors such as diabetes, consume little or no calcium in their diets or have had recent fractures.
Children who have had a long period of inactivity such as may occur in a prolonged hospitalization or those who have decreased mobility due to a disease.
Children with a parental or grand-parental history of osteoporosis that occurred early in life.

The evaluation

Before your first visit, your child will need blood tests. (These may include a vitamin D profile, parathyroid hormone, thyroid studies and a comprehensive metabolic panel.)
A urinalysis with spot check for phosphorus and creatinine will be ordered. In addition, special 24-hour collections for analysis may be requested.
A dual-energy x-ray absorptiometry (DEXA) scan is ordered to be completed at least one week prior to the visit. DEXA is a special kind of x-ray that measures bone mineral density. Due to the specialized nature of this testing, the test must be ordered and completed at our hospital. This is because we use software specific to pediatrics, and individual results are tabulated based upon comparisons to an extensive database. A dedicated team of a specialized radiologist and technicians perform and interpret these tests according to stringent guidelines.
An x-ray called a bone age study (usually involves a single x-ray of the left wrist and hand) and a skeletal survey (x-rays of all the bones in the body) may be ordered. A bone age study is especially valuable in accurately interpreting a DEXA scan since chronological age may not always be accurate. A skeletal survey is extremely valuable when looking for genetic causes of juvenile osteoporosis.
Your child's outpatient visit at our Lincoln Park Clark/Deming building will include a comprehensive evaluation and a review of the test results, after which an individualized treatment plan will be developed.

What are potential treatment options?

Nutrition is a cornerstone of bone health. We provide dietary education and individualized plans to optimize your child's calcium and vitamin D levels.
We may recommend short-term uses of mediations that block bone breakdown.
We may devise an individualized plan for increasing weight-bearing activities.
In addition to excellent clinical care, we believe that by staying abreast of the most recent research that is setting up best practices in the growing field of bone health, we are able to carry out the most current evaluation, testing and treatment methods available.

Our multidisciplinary team

As one of only seven free-standing pediatric centers in the nation with a dedicated Bone Health Program, and the only pediatric program in Illinois, our multidisciplinary team collaborates to develop the best, most comprehensive treatment plan for a patient. Our team includes: