It's not Just Growing Pains: A Guide to Childhood Muscle, Bone, and Joint Pain, Rheumatic Diseases, and the Latest Treatments

By Thomas J. A. Lehman | Go to book overview

21
Osteoporosis and
Osteopenia

Charlotte was twenty-one years old when I first met her. She had been
cared for by another rheumatologist for many years, but was referred to
my hospital because of her need for joint replacement surgery. She was
diagnosed with juvenile arthritis at the age of twelve years and treated
with corticosteroids when her disease did not respond to NSAIDs. She
felt much better with the corticosteroids and was able to attend school
and go on to college. During the college years, Charlotte was away
from home and managed her own medications. Although she was offi-
cially on a low dose of corticosteroids, Charlotte freely admitted that
when she felt stiff or sore she would take extra. Charlotte completed
college with honors and planned to go on to graduate school. However,
she had fallen and broken her hip. X rays revealed that the hip had
broken because her bones were so weak. Further evaluation revealed
that she had weak bones throughout her body. Over the next few years
she suffered multiple fractures with even the slightest injury. She con-
tinues with multiple operations, and because of her many problems she
has never been able to attend graduate school.

Osteoporosis and osteopenia are conditions involving decreased bone mass and hence a decrease in the strength of the bones with an increased risk of fractures. A person has osteopenia if their bone mass is more than one standard deviation below the normal level and osteoporosis if their bone mass is more than two and a half standard deviations below the normal level. These definitions have been difficult to apply to children because the normal levels have not been well defined for children of different ages and races. However, precise medical definitions are not what parents should be concerned about. What it is important for parents to understand is that

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