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 Vol. 20 No. 3, September 2008
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AAP Grand Rounds 20:34-35 (2008)
© 2008 American Academy of Pediatrics

ORTHOPAEDICS

Evaluation of Children With Frequent Fractures

Source: lney RC, Mazur JM, Pike LM, et al. Healthy children with frequent fractures: how much evaluation is needed? Pediatrics. 2008;121(5):890–897; doi:10.1542/peds.2007–2079[Abstract/Free Full Text]

The first 20% of the full text of this article appears below.


PICO

Question: Among children with multiple low-energy bone fractures, what is the risk of occult bone disease?

Question type: Prognosis

Study design: Case control

 

Investigators at the Nemours Children’s Clinic, Jacksonville, Florida, undertook a case-control study to determine if children with two or more low-energy fractures have occult bone disease.

Case subjects included healthy children 3–17 years of age seen at an orthopedic clinic. Low-energy fractures were fractures not associated with motor vehicles, bicycles, skateboards, monkey bars, or falls from more than standing height. Children with a history of any disease or syndrome associated with low bone mineral density (BMD) or fractures, a history of corticosteroid or antiepileptic medication use, a history of prolonged immobilization, spina bifida, or a history of spinal surgery were also excluded.

Control subjects included a mixture of siblings and unrelated children without history of fracture. Children underwent bone density testing via dual-energy radiographic absorptiometry (DXA) evaluation, Tanner staging, nutritional intake evaluation (three-day diet history), and laboratory testing (including parathyroid hormone, thyrotropin, vitamin D levels, . . . [Full Text of this Article]

Larry A. Greenbaum, MD, PhD, FAAP
Pediatrics, Emory University and Children’s Healthcare of Atlanta, Atlanta, GA