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01-03-2012 | General practice | Article

Fracture-prone children ‘need careful assessment’


Free abstract

MedWire News: Children who suffer repeat low-energy fractures warrant a thorough evaluation for potentially modifiable risk factors, say Finnish researchers.

Their study found that fracture-prone children typically had lower bone mineral density (BMD) and were nutritionally deficient compared with fracture-free children, strengthening the case for screening of the former group.

Mervi Mäyränpää (Children's Hospital, Stenbäckinkatu) and colleagues undertook a prospective case-control study. Over a 12-month period, they recruited all apparently healthy children aged 4 years and over who presented with an acute fracture and had a history of (i) at least one low-energy vertebral fracture; (ii) two long-bone fractures before age 10; or (iii) three long-bone fractures before age 16.

A total of 66 such children were identified; 44 were male and their mean age was 10.7 years. They had suffered a total of 183 long-bone fractures and 11 vertebral fractures, giving a median of three fractures per child.

Each of these fracture-prone children was matched for age and gender with a child with no history of bone fracture.

BMD at the lumbar spine, hip, and whole body was significantly lower in cases than controls; these findings persisted in several subgroup analyses defined by age, pubertal development, and gender.

Actual osteoporosis was extremely rare, however, affecting just five children in total.

With regard to biochemistry results, case children had significantly higher levels of calciuria and higher ratios of urinary calcium to creatinine compared with controls. Cases also had a significantly higher prevalence of hypercalciuria and hyperphosphaturia than controls.

Worryingly, spinal radiography revealed 10 previously undetected vertebral compression fractures in five children with a known traumatic vertebral fracture, and 12 such compression fractures in eight children with a known long-bone fracture.

Children with newly detected asymptomatic vertebral fractures had significantly lower vitamin D levels, lower BMD at the lumbar spine, and were more significantly likely to have vitamin D deficiency than children without vertebral compressions.

Finally, risk factors for fracture included having a sibling with fractures, reporting below-average mean daily calcium intake, and having less than 7 hours of physical activity per week.

"Based on our findings it is of key importance to first target the dietary and other lifestyle factors, supplement with vitamin D and calcium and only if these prove to be inadequate during follow up, consider bisphosphonate treatment," the authors conclude.

"Further follow-up studies and repeated evaluations are needed to understand the role of various lifestyle factors on fracture prevention in children."

By Lynda Williams

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