Focus on Pediatrics: Early bone health is a must-know for teens

Before 25 is prime time for building bones

The National Osteoporosis Foundation in Washington, DC, estimates that the prevalence rate for osteoporosis among women ages 50 and older is 30 million. Prevention is key, but women can’t wait until they are middle-aged to focus on bone health. Up to age 25 is the peak period for building bone mass, and the teen-age years are critical.

"Young women need to be convinced that they should take action to prevent osteoporosis as a teen because it is at that age that they can do the most to give themselves added protection against it," says Felicia Cosman, MD, clinical director.

The higher a woman’s bone mass when she enters menopause, the greater likelihood she will be able to stay above the fracture-range bone mass level despite the bone loss that occurs with age.

Teens need to understand that certain health behaviors at this stage of their lives will impact their future. One way to convince them is to make it personal, says Cosman. For example, by reviewing family history, many will realize that the hip fracture Grandma had that put her in a nursing home was a result of osteoporosis.

Prevention begins with calcium consumption. Teen-agers need 1,300 mg of calcium daily. They will get the right amount if they eat a well-balanced diet, making sure they include three to four servings of foods rich in calcium a day. These can be foods containing dairy products such as macaroni and cheese or cereal with milk. Calcium-fortified foods such as breakfast bars, waffles, and juice are good sources, too.

It is important for teens to pay attention to their calcium intake because it is easy to have a low-calcium day. For example, a bagel for breakfast, turkey sandwich for lunch, and a hamburger for dinner result in a low-calcium day. However, starting the day with cereal and milk, drinking chocolate milk for lunch and having pizza for dinner ensures that the right number of servings was consumed for the day.

While it is best to get calcium from foods, if teens do not, then they should take a calcium supplement, says Cosman.

A second important prevention strategy is exercise, she says. "Teens should exercise four to five times a week, and the physical education programs they do in school are generally not adequate," she says. The exercise preferably should be weight bearing and might include dance, walking, a racquet sport, jogging, or aerobics classes. Organized sports such as volleyball or basketball are good as well. However, if a teen signs up for a fall sport, she needs to find other forms of exercise that she enjoys during the other seasons.

Teen-age girls never should smoke because smoking cigarettes is disastrous to bone health, Cosman cautions. It impairs the normal process of bone formation, and that can impact the amounts of bone they gain by the peak.

The fourth factor in bone health is having regular menstrual periods. If a teen-ager is not menstruating regularly, she should be examined by a physician to determine why and treated accordingly, she says. Often eating disorders, such as anorexia, could be the problem, or it could be a hormonal reason. Excessive exercise also can cause menstrual periods to stop.

Teens should be taught all four practices for bone health. "We have found that during this adolescent phase of life, girls can not only increase the bone mass at peak but also bone size. Increasing the diameter of the bone can also dramatically improve bone strength," says Cosman.


For more information about educating teenagers about bone health, contact:

  • Felicia Cosman, MD, clinical director, National Osteoporosis Foundation, 1232 22nd St. N.W., Washington, DC 20027-1292. Telephone: (202) 223-2226. Web site: