Jason, age 13, has twice fractured his forearm after falling during soccer games. He has no history of other fractures or chronic illness. He rarely drinks milk and often eats fast food for dinner. He has a body mass index of 29, height at the 50th percentile and Tanner stage 3 development (mid-puberty). His grandmother died after a hip fracture at age 80.

His orthopedic surgeon launched a bone health workup. Jason’s vitamin D level was 16 ng/mL and his bone densitometry scan (DXA) T-score was -2 for hip and spine. The DXA report concluded that Jason had “osteopenia.” Jason’s parents are worried and his physician has advised that he not participate in sports until this issue is resolved. What would you do?

This scenario is familiar to many pediatricians who are paying increased attention to bone health. Low bone mass and fractures complicate several genetic and acquired chronic disorders...

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