Children with chronic rheumatic disease are at an increased risk of compromised bone health. This is due to multiple reasons.
Chronic inflammation by itself leads to loss of muscle and fat mass; besides, certain medications used in the treatment and induction of remission in rheumatic diseases, especially corticosteroids, can affect the bone health adversely.
Another very important factor is altered lifestyle. Children with rheumatic disease have reduced sun exposure and physical activity and exercise; they may also have obesity as a side-effect of certain medications. All these factors lead to a state of bone loss, affecting the bone mass of the child and potentially leading to fragility fracture.
It is therefore very important for affected children to undergo routine screening for bone health, and also for parents to follow the doctor’s advice and use medications as recommended. Some advice and instructions for ensuring good bone health are:
a) Medications: Taper steroids as advised by the doctor, use steroid sparing medications.
b) Compliance: Keep the disease under control by complying with instructions for medication and follow-ups.
c) Supplements: Ensure regular intake of calcium and vitamin D supplements.
d) Bone health screening: Have your child undergo blood tests (alkaline phosphatase, calcium, phosphorus, vitamin D levels, bone mineral density) as recommended by the doctor.
e) Diet: Ensure regular meals, a balanced diet and suitable portion sizes, including calcium and vitamin D rich foods.
f) Exercise / physiotherapy: Physical activity is important as it will help increase the bone strength during the growth period of the child.