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What Is a Metabolic Bone Disorder in Children?
This guide to metabolic bone disorders in kids explains what causes these bone issues, how a metabolic bone disorder is diagnosed and treated, and what can be done to protect children’s bone health.
Advice to improve your movement, fitness, and overall health from the #1 in orthopedics in the U.S.
If you’ve heard that a child has a metabolic bone disorder, you might wonder what that means. Metabolic bone diseases affect how bones both break down and form. They can cause bones to be weak, break easily or form differently, says Alyson Weiner, MD, a pediatric endocrinologist at HSS. Kids with these disorders might have bones that are softer, thinner, or not shaped properly.
Some children have these problems because of issues with hormones, their genes, their diet, or other health problems like kidney or celiac diseases. Two common bone problems in kids are osteoporosis and rickets. Osteoporosis means the bones are not very dense and can break easily. Rickets, a condition that results in weak bones, is most commonly caused by vitamin D deficiency, says Dr. Weiner.
“In pediatrics, we want to make sure we're being as cautious as possible to preserve bone health, says Dr. Weiner. “The bones grow the most during childhood and adolescence, then it generally peaks in late adolescence/early adulthood, and further declines from there.”
Symptoms of a Metabolic Bone Disorder in Kids
One of the biggest signs there’s a potential problem with a child’s bone health is if they keep breaking bones. “We suggest seeing an endocrinologist if a child is having multiple fractures with no clear cause,” Dr. Weiner suggests.
If your child has had the following, they may have pediatric osteoporosis:
- One or more vertebral fractures (in the bones of the spine)
- Three or more long bone (femur, humerus, fibula, tibia, radius, ulna) fractures before age 19
- Two or more long bone fractures before age 10
Other signs your child might be predisposed to having weaker bones:
- Dental issues like early tooth loss or multiple cavities at a young age
- Multiple broken bones
- Bowing of the legs
- Having celiac disease, systemic lupus erythematosus (SLE), chronic kidney disease, thyroid disease, type 1 diabetes, or a rheumatologic condition
- Undergoing cancer treatment
- Taking steroids
- If the child complains of bone pain
How is a Pediatric Metabolic Bone Disorder Diagnosed?
A pediatric endocrinologist will usually check the child with a physical exam. The child might need to have blood tests and a urine test. Sometimes, the doctor will order a bone density scan (called DXA) to see how strong the bones are, says Dr. Weiner. An X-ray may also be done if the doctor wants to look closely at the bones and growth plates.
Treatment of Metabolic Bone Disorders in Kids
Getting enough calcium is important for building strong bones. That being said, some kids have genetic issues that make it hard for their bodies to use calcium, phosphorus or vitamin D properly.
The kind of bone problem a child has helps doctors decide the best treatment. If the child does not have enough vitamin D or calcium, the doctor will suggest taking vitamin D or calcium. Kids may also be encouraged to do physical therapy to help make their bones stronger and build strength.
Depending on the cause of bone disease and the severity, the child might receive a bisphosphonate infusion to help strengthen the bones and lower the risk of a fracture, Dr. Weiner says.
Preventing Metabolic Bone Disorders in Kids
Some bone problems in children can’t be avoided if they are genetic, but eating well and staying active are important ways to help keep kids’ bones strong.
“The best way to optimize bone health in general is with sufficient vitamin D intake, appropriate calcium intake for age, and doing weight-bearing activities,” says Dr. Weiner.
Vitamin D is found in sunlight and also in certain foods that we eat. “Breastfed infants are at a higher risk of vitamin D deficiency, so it is important to discuss supplementation with your doctor,” says Dr. Weiner. “Over time, severe vitamin D deficiency can lead to rickets.”
Published 10/1/2025
