Committee on Nutrition: Optimising bone health in children and adolescents
The latter half of school-age years represents the fastest period of bone growth and calcium accretion in an individual's life, after which bine mineralisation only declines. This clinical report reviews all major aspects of normal bone acquisition in infants, children, and adolescents and discusses factors affecting bone health in this age group. Key summary messages: The paediatrician plays a major role in helping optimise bone health in children and adolescents. The recommendations for daily allowances for calcium and vitamin D are updated, and clinical guidance is provided regarding weight-bearing activities and recommendations for calcium and vitamin D intake and supplementation. Increased dietary intake to meet daily requirements is encouraged, and routine calcium supplementation is not recommended for healthy children and adolescents. The recommended dietary allowances for vitamin D are reviewed, as well as support for testing for vitamin D deficiency in children and adolescents with conditions associated with increased bone fragility. The review does not recommend universal screening for vitamin D deficiency in healthy children or in children with dark skin or obesity because there is insufficient evidence of the cost-benefit of such a practice in reducing fracture risk. The paper supports the use of dual-energy x-ray absorptiometry as the preferred test to assess bone health, but advises caution in interpreting results in children and adolescents who may not yet have achieved peak bone mass. Finally, the report provides office-based strategies for the paediatrician to optimise bone health in children.