Revista de Medicina Desportiva (English) January 2019 | Page 16

indicates that, for example, the cost
of a hip fracture, during the first
year after the fracture, was13434.00€
and during the 2 nd year it was equal
to 5985.00€, and total expenses
was 216 millions of euros. In the
European Community, and during
the year of 2010, it s estimated an
expense of 37 billions of euros with
osteoporosis, which were related
with the treatment of the fractures
(66%), with pharmacological preven-
tion (5%) and 29% related to long
term costs. Close to us, in Spain, and
also for the year of 2010, the cost
of previous and current fractures is
about 2842 millions of euros / year
and it is estimated that for the year
2050 the cost will increase to 3,68
billions.
Bibliography
1. International Foundation of Osteoporosis.
https://www.iofbonehealth.org/facts-
-statistics#category-22. Consultado em
novembro de 2018.
2. Rodrigues AM, Canhão H, Marques A,
Ambrósio C et al. Portuguese recommenda-
tions for the prevention, diagnosis and mana-
gement of primary osteoporosis – 2018 update.
Acta Reumatol Port. 2018; 43:10-31.
3. Hernlund E, Svedbom A, Ivergard M,
Compston J, et. al. Osteoporosis in the Euro-
pean Union: Medical Management, Epidemio-
logy and Economic Burden. A report prepared in
collaboration with the International Osteopo-
rosis Foundation (IOF) and the European Fede-
ration of Pharmaceutical Industry Associations
(EFPIA). Arch Osteoporos 2013; 8:136.
4. Svedbom A, Hernlund E, Ivergard M, et
al. Osteoporosis in the European Union: A
compendium of country-specific reports. Arch
Osteoporos 2013; 8:136.
occur on children and adolescents,
in particular in association with
systemic diseases, like leukemia,
chronic inflammatory diseases, and
therapeutics like systemic corticoids,
hypogonadism and malnutrition
(secondary osteoporosis). Primary
osteoporosis is a rare condition,
being the most frequent cause of
osteogenesis imperfect (incidence of
1:25 000).
The bone mineral deposition
starts during pregnancy and about
two thirds of it occurs during the
last trimester. The bone mineral con-
tent increases 40 times since birth
until adult age and the peak of BM
is reached at the end of the second
decade of life, although there still
can exists some deposition during
the third decade. About 40 to 60% of
BM on the adult person is acquired
during adolescence and at the age
of 18 years about 90% of the peak of
BM is already reached.
The childhood and the adoles-
cence are, therefore, critical periods
for skeletal mineralization and any
condition that negatively interferes
with the peak of BM increases the
risk for osteoporosis and fractures
during adulthood. In fact, evidence
shows that the BM achieved during
the first two decades of life are the
most important modifiable determi-
ning factor for bone health throu-
ghout adult life. This is, the bone
patrimony is achieved and optimi-
zed during pediatric age, where the
preventive measures during this age
period are very important. The fac-
tors affecting the acquisition of bone
mass are indicated on Table 1.
Table 1. Determinant factors for acquisi-
tion of bone mass
Not modifiable
Genetics
Gender
Dra. Carla Laranjeira.
Pediatrics.
Bone health optimization –
preventive measures during
pediatric age
Osteoporosis is characterized by the
reduction of the bone mass (BM) and
by deterioration of the microarchi-
tecture, causing bone fragility and
risk for fractures. This pathology is
not only related to ageing, and it can
14 january 2019 www.revdesportiva.pt
The genetic factors are responsible
for about 70% of the variations on
BM, although no specific gene has
been identified. Men have bigger
bone mineral density than women
and black people have bigger BM
than the Caucasians.
With greater detail, we’ll approach
the more determinant modifiable
factors for acquisition and mainte-
nance of BM during pediatric age.
Calcium
Calcium s fundamental for bone
mineralization and the dietetic
ingestion of calcium during child-
hood and adolescence is an impor-
tant determinant for its acquisition.
Several studies prove the relation
between bone mineral density at
adult age and the ingestion of cal-
cium during childhood and adoles-
cence. About 99% of the corporal
calcium is located at skeleton and
calcium is absorbed by passive and
active transport, the later being
mediated by vitamin D. If there isn’t
vitamin D, only 10-15% of the calcium
from the diet is absorbed. Table 2
indicates the needs of diet calcium
ingestion during pediatric age.
Table 2. Needs of diet calcium ingestion
during pediatric age
Age Recommendations
for diet ingestion of
calcium (mg/day)
0 – 6 months 200*
6 – 12 months 260*
1 – 3 years 700
4 – 8 years 1,000
9 – 13 years 1,300
14 – 18 years 1,300
14 – 18 years,
pregnant/
lactating 1,300
* Adequate ingestion – Institute of Medicine, 2010
Ethnicity
Modifiable
Nutrition
Calcium
Vitamin D
Sodium
Protein
Soft drinks
Physical exercise and life style
Weight and body composition
Hormonal status
Milk and its derivatives represent
the main source of calcium on the
diet, corresponding to about 70-80%
of the needs of calcium during
pediatric age. Each portion of 240ml
of milk furnishes about 300mg of
calcium and the content of calcium
in milk with lower fat is similar to
the plain milk. Two yogurts or 40gr
of cheese (about two slices) furnish
300mg of calcium.