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What is pediatric osteoporosis?

Pediatric osteoporosis is a condition in which children have reduced bone density and strength, making their bones more likely to fracture. Bone strength reflects both bone density and bone quality. Although osteoporosis is more common in adults, it can occur in children when normal bone development is disrupted.

Most cases of pediatric osteoporosis are caused by an underlying medical condition or certain medications. This is called secondary osteoporosis. In rare cases, when osteoporosis occurs without a known cause, it is called idiopathic juvenile osteoporosis (IJO). At Boston Children’s Hospital, we see children with osteoporosis in our Skeletal Health Center.

Symptoms & Causes

What are the symptoms of pediatric osteoporosis?

Pediatric osteoporosis is typically asymptomatic until a fracture occurs.

Fractures are common in healthy children, especially during active play. In fact, up to 50 percent of children will have at least one fracture during childhood (often in ankles, wrists, fingers, and toes). Most of these fractures are normal and do not indicate an underlying bone problem.

The most common sign of pediatric osteoporosis are recurrent fractures (broken bones), especially:

  • Fractures of the larger bones of the arms and legs
  • Fractures from low-impact or minimal trauma
  • Fractures of the vertebral spine (spinal compression fractures), which can occur without obvious symptoms and should always prompt further evaluation.

What causes pediatric osteoporosis?

Most cases of pediatric osteoporosis are caused by an underlying condition, certain medications, or other factors. This is called secondary osteoporosis.

Conditions that can lead to secondary osteoporosis in children include:

Medications that can lead to secondary osteoporosis in children include:

  • Anticonvulsants
  • Corticosteroids
  • Immunosuppressive medications

Other contributing factors include:

  • Low calcium or vitamin D intake 
  • Limited weight-bearing activity or prolonged immobility 
  • Excessive physical training without adequate nutrition

Diagnosis & Treatments

How is pediatric osteoporosis diagnosed?

If osteoporosis is suspected, your child’s care team will perform a physical exam and review their medical history. Testing may include:

  • Bone density testing (DXA scan) to measure bone mineral density
  • Blood tests to evaluate calcium, vitamin D, and other markers
  • X-rays to look for fractures, especially in the spine

In children, osteoporosis is not diagnosed based on bone density alone. Diagnosis typically requires a combination of low bone density (Z-scores) and a history of clinically significant fractures.

How is pediatric osteoporosis treated?

Treatment focuses on improving bone strength and addressing underlying causes when possible. This may include:

  • Treating underlying medical conditions
  • Optimizing calcium and vitamin D intake
  • Encouraging safe, weight-bearing physical activity
  • Supporting overall nutrition and growth

In some cases, osteoporosis medications may be recommended to improve bone strength, particularly for children with fractures or more severe disease.

How we care for pediatric osteoporosis at Boston Children’s Hospital

In Boston Children’s Skeletal Health Center, we see children of all ages with pediatric osteoporosis. We take a team approach to care, bringing together experts in endocrinology, orthopedics, and other disciplines. We also work closely with our colleagues in the hospital’s DXA Bone Density Program to monitor bone mineral density and better understand your child’s risk of fractures. We develop individualized care plans that support each child’s bone health, growth, and overall well-being.