Adolescent and Young Adult Bone Health

Adolescents and young adults (AYA) with chronic rheumatic musculoskeletal diseases (RMDs) have multiple potential risk factors for compromised bone health. The effect of the active inflammatory disease state on bone resorption, malnutrition, reduced physical activity, delayed puberty, vitamin D deficiency and use of glucocorticoid therapy can all result in impaired bone accrual. The impact of chronic RMDs on bone density can extend into adulthood, and coupled with the inevitable bone loss during ageing, may lead to increased fragility fractures throughout life. Although many tools can be used to determine bone health, the most useful and widely used technique by far is dual-energy X-ray absorptiometry (DXA).

Low bone mineral density (BMD) can be asymptomatic, hence AYAs with chronic RMDs may benefit from routine bone health screening. Specific measures include the use of vitamin D and calcium supplements, steroid-sparing medications and the promotion of weight-bearing exercise. This chapter addresses common risk factors for adverse bone health in AYAs with RMDs and explores the broad approach to prevention and management of bone fragility.