Peer-reviewed article
Multi-nutrient Optimization for Skeletal Advancement and Integrated Care in Pediatric Bone Health (MOSAIC-PBH): An Expert Consensus From India
Uday Pai, Ashwani Kumar, AV Ravishankar, Mahesh Sulakshane ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This is an expert consensus from India on how nutrition supports bone health in children. A panel of 23 experts used a modified Delphi process, after a structured literature review, to agree on statements. The panel notes that shortfalls in vitamin D, calcium, magnesium and zinc are common and often go unrecognised. It recommends risk-based screening, clinical assessment, and nutrition management that looks at several nutrients and lifestyle factors together, with attention to early life and adolescence. The authors say better clinical studies are still needed.
Key points
- A multidisciplinary panel of 23 experts used a modified Delphi process with a single anonymised voting round; agreement was defined as 75% or more.
- Dietary inadequacy and subclinical deficiency of vitamin D, calcium, magnesium and zinc may be a considerable burden in children.
- Bone health is described as a system in which structural minerals, regulatory cofactors and hormonal pathways depend on each other.
- A life-course approach is seen as essential, with critical windows in early life and adolescence.
- The panel recommends risk-based screening, comprehensive clinical assessment and context-specific nutritional management, and gives guidance on formulation, dosing and implementation.
Limitations
This is expert opinion based on a single Delphi round, not a test of an intervention, so it cannot show that multi-nutrient approaches improve bone outcomes or reduce fractures. The authors state that high-quality clinical studies are still needed.
Abstract
Micronutrient deficiencies in children are common, often coexisting and subclinical, yet remain underrecognized.This expert consensus aims to provide an integrated framework for pediatric bone health, emphasizing multi-nutrient interactions and strategies to support adequate bone accrual and peak bone mass during growth.This consensus was developed using a modified Delphi methodology involving a multidisciplinary panel of 23 experts.A structured review of the literature was conducted to synthesize evidence on nutritional determinants, bone biology, and clinical management.Consensus statements were developed and subjected to a single-round anonymized Delphi voting process, with agreement defined as ≥75%.This expert consensus highlights the potential burden of dietary inadequacy and subclinical deficiency of key micronutrients, including vitamin D, calcium, magnesium, and zinc.Evidence supports a systems-based model of bone health, emphasizing the interdependence of structural minerals, regulatory cofactors, and hormonal pathways.A life-course approach was identified as essential, with critical windows during early life and adolescence.The panel recommends risk-based screening, comprehensive clinical assessment, and a context-specific approach to nutritional management that considers multiple nutrient and lifestyle factors for prevention and management.Practical guidance on formulation, dosing considerations, and implementation strategies is also provided.Pediatric bone health may benefit from a comprehensive, multi-nutrient and multi-mineral framework that complements assessment and management of individual nutrient deficiencies and is aligned with underlying physiology.Adoption of riskbased, life-course strategies and context-specific nutritional interventions may support skeletal health, while high-quality clinical studies are needed to establish the effects of multi-nutrient interventions on bone outcomes and fracture risk.