Improving Bone Health

For all children and teens, bone health is important. The amount of bone tissue in the body is known as bone mass. It keeps growing throughout puberty. By age 20, bones have reached their maximum strength. Ninety percent of bone growth happens before age 20.

Children and teens with IBD may be at risk for low bone density (LBD). Low bone density makes bones weaker. Patients with height delay and patients with low BMI (body mass index) may be at higher risk. Long-term use of corticosteroids is also a risk factor for LBD. Malabsorption of nutrients and active disease contribute to the risk of LBD. Low bone density may lead to osteoporosis and fractures. Osteoporosis is a disease that weakens bones and can lead to bones becoming thinner and less dense.

Bone density and improving bone health is something to talk to your IBD care team about. Here are some things to consider:

Measuring and Assessing Bone Health with IBD

A DEXA scan is a dual x-ray absorptiometry scan. It is a non-invasive scan that measures bone density by passing an x-ray beam through the body. There is currently no consensus on regular DEXA scans for every pediatric patient with IBD.

Talk to your health care team about Vitamin D levels and risk factors of bone loss. Ask your doctor about the need for a DEXA scan. Speak with a dietitian about ways to adjust your diet for optimal bone health.

Dietary Recommendations for Optimal Bone Health

Because every patient is different it is important to note that this is intended to be general information. We always recommend talking with a dietitian to assess your specific dietary needs and make a plan.

A healthy diet is important for all children and teens and can help improve bone health. One example of a healthy diet includes low-fat dairy, fruits and vegetables, and whole grains. However, this diet may not work for all people. Some patients may need to avoid dairy, while others may need to limit fruits, vegetables, and whole grains. And some patients may not be eating solid food at all.

Important nutrients for children and teens with IBD

✅ Vitamin D

Getting enough vitamin D is especially important for growing kids, because it is involved in bone growth, bone density and bone strength, and in growth itself. For detailed information on Vitamin D, please read our post No bones about it - Vitamin D & IBD

✅ Calcium

Calcium is a mineral that is needed to build and maintain strong bones. Calcium is not made in the body. It is absorbed from the foods we eat. If you do not eat enough foods rich in calcium, calcium is removed from your bones and they can become weaker.

🧀 Foods rich in calcium

- Milk, yogurt, cheese and other dairy products (150 – 400 mg/serving)

- Kale, broccoli and other green leafy vegetables (20 – 100 mg/serving)

- Tofu (350 – 400 mg/serving)

- Almonds (75 – 100 mg/serving)

- Calcium-fortified cereals and juices (180 – 300 mg/serving)

* Foods that contain dairy, like cheese pizza or cheese enchiladas, can also add calcium to the diet. It is important to also limit intake of soft drinks in children and teens. Phosphates in soda decrease calcium absorption in the bone

🧀 Calcium Recommended Dietary Allowance (RDA) by age

🧀 How to get calcium if you are lactose intolerant

- Choose non-dairy sources of calcium, such as almond, pea, and coconut milks and frozen desserts

- Select dairy that has been treated to be lactose-free

- Use a calcium supplement (talk to your health care team)

- Use lactase drops to reduce the lactose in milk and dairy      

✅ Magnesium

Magnesium is found in bone crystals and improves bone strength. Foods high in magnesium include pumpkin and chia seeds, almonds and cashews, black beans and soy milk. Add them to your diet!

✅ Vitamin K

Vitamin K is needed for bone formation. You can get Vitamin K from green leafy vegetables, broccoli, soybeans and soy oil and nuts.

✅ Vitamin C

Vitamin C is important for synthesis of collagen. Collagen is the main protein in bone. Foods rich in Vitamin C include citrus fruits, strawberries, tomatoes, and bell peppers. Consider adding these to your diet!

Summary on Improving Bone Health

Ninety percent of bone growth happens before age 20. Children and teens with IBD may be at risk for low bone density (LBD). Whether following a strict diet to help manage IBD or eating an unrestricted diet, young people with IBD and their families can look for ways to support bone growth and strength through diet. If possible, work with a dietitian as part of multidisciplinary IBD care.

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This post was written by Lesley Stanford MS, RD, LDN, Pediatric Nutritionist, Duke University Medical Center and members of the ICN Registered Dietitian group. Do not rely on the information in this document to diagnose or treat any health condition. This information does not constitute medical advice and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Disclaimers posted at improvecarenow.org/icn_tools_disclaimer apply to this document.

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