Multi-nutrient Optimization for Skeletal Advancement and Integrated Care in Pediatric Bone Health (MOSAIC-PBH): An Expert Consensus From India
4 affiliations
- 1Pediatrics, Sai Kutir Clinic, Mumbai, IND
- 2Pediatric Medicine, Adesh Medical College And Hospital, Mohari, IND
- 3Pediatrics, M. K. Hospital, Chennai, IND
- 4Pediatrics and Child Health, Dr. Sulakshane Multispecialty Clinic, Pune, IND
Abstract
Micronutrient deficiencies in children are common, often coexisting and subclinical, yet remain under-recognized. 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 risk-based, 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.
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BibTeX
@article{pai2026multinutrient,
title = {{Multi-nutrient Optimization for Skeletal Advancement and Integrated Care in Pediatric Bone Health (MOSAIC-PBH): An Expert Consensus From India}},
author = {Uday Pai and Ashwani Kumar and AV Ravishankar and Mahesh Sulakshane},
journal = {Cureus},
year = {2026},
month = oct,
doi = {10.7759/cureus.117377},
url = {https://europepmc.org/article/PMC/PMC13725260},
note = {CC BY},
}
RIS
TY - JOUR
TI - Multi-nutrient Optimization for Skeletal Advancement and Integrated Care in Pediatric Bone Health (MOSAIC-PBH): An Expert Consensus From India
AU - Uday Pai
AU - Ashwani Kumar
AU - AV Ravishankar
AU - Mahesh Sulakshane
PY - 2026
DA - 2026/10/03
JO - Cureus
DO - 10.7759/cureus.117377
UR - https://europepmc.org/article/PMC/PMC13725260
AB - Micronutrient deficiencies in children are common, often coexisting and subclinical, yet remain under-recognized. 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 risk-based, 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.
SN - 2168-8184
ER -