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Bone Health in Adolescents with Chronic Disease

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A Practical Approach to Adolescent Bone Health

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Abstract

Adolescence is a critical window for bone mass accrual during which skeletal mass is expected to double. Chronic disease in adolescence can have wide-ranging consequences for bone health, not only related to the direct effects of the underlying disorder on bone development but also to disease-related comorbidities and treatments that may exert a negative impact on bone. Common risk factors for decreased bone mineral density and fractures in adolescents with chronic disease include sex hormone deficiency, decreased physical activity, impaired linear growth, decreased lean body mass, chronic inflammation, and prolonged use of systemic glucocorticoids. The purpose of this chapter is to describe the pathophysiology, presentation, screening, and management of bone disease in common chronic conditions affecting adolescents including type 1 diabetes mellitus, celiac disease, inflammatory bowel disease, cystic fibrosis, chronic kidney disease, cancer, and hypogonadism. Emerging literature on various other childhood conditions will also be reviewed. Optimal control of bone and mineral homeostasis in adolescents with chronic diseases is essential not only for the promotion of adequate growth but also for the prevention of debilitating skeletal complications. Treatment strategies for poor bone health associated with chronic disease in adolescents include optimizing nutrition, maintaining vitamin and mineral homeostasis, encouraging weight-bearing exercise, minimizing treatment of the underlying disease with glucocorticoids or other bone-impairing medications, and treating the underlying disorder in order to prevent further bone impairment.

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Authors and Affiliations

  1. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA

    Erin H. Sieke

  2. Department of Pediatrics, The Craig Dalsimer Division of Adolescent Medicine, The Children’s Hospital of Philadelphia/Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA

    Rebecka Peebles

Authors
  1. Erin H. Sieke
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  2. Rebecka Peebles
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Correspondence to Rebecka Peebles .

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Editors and Affiliations

  1. Divisions of Adolescent Medicine and of Endocrinology, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

    Sarah Pitts

  2. Division of Adolescent and Transition Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA

    Catherine M. Gordon

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Sieke, E.H., Peebles, R. (2018). Bone Health in Adolescents with Chronic Disease. In: Pitts, S., Gordon, C. (eds) A Practical Approach to Adolescent Bone Health . Springer, Cham. https://doi.org/10.1007/978-3-319-72880-3_11

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  • DOI: https://doi.org/10.1007/978-3-319-72880-3_11

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