Optimising Bone Health in Adolescents: Preventing Poor Bone Accrual and Secondary Osteoporosis.

Bone health during adolescence is influenced by a complex interplay of various factors, disruptions in which may impair bone mineral accrual and predispose to both primary and secondary osteoporosis. Adolescents with chronic medical conditions are at particularly high risk of skeletal deficits. Clinical data from Indian cohorts demonstrate a high burden of low bone mineral density in these populations, with important observations such as the presence of vertebral fractures even in adolescents with BMD Z-scores above -2.0, highlighting the limitations of relying on densitometry alone. Assessment of bone health requires careful interpretation of dual-energy X-ray absorptiometry in the context of growth, with use of size-adjusted measures such as bone mineral apparent density. Vertebral fracture assessment may improve detection of clinically silent skeletal fragility. Optimisation of bone health includes ensuring adequate nutrition, promoting physical activity, and managing underlying disease, with pharmacological therapy considered in selected cases. Early identification and targeted intervention during adolescence provide an opportunity to improve peak bone mass and reduce long-term skeletal morbidity.