Association Between Bone Mass and Fractures in Children: A Prospective Cohort Study

Clark, Emma; Ness, Andy R; Bishop, Nicholas; Tobias, Jonathan H

doi:10.1359/jbmr.060601

Cited by 321 publications

(244 citation statements)

References 31 publications

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“…In contrast to adults, in pediatrics, there is no specific BMD z score below which fractures are more likely to occur, but there is a growing body of literature demonstrating an association between low bone mass measured by using DXA and fracture risk in children. [113][114][115] Limited evidence is available to guide pediatricians regarding when to order a DXA. In general, a DXA should be performed to identify children and adolescents at risk for skeletal fragility fractures and to guide treatment decisions.…”

Section: Assessment Of Bone Healthmentioning

confidence: 99%

Optimizing Bone Health in Children and Adolescents

Daniels¹,

Abrams²,

Corkins³

et al. 2014

Pediatrics

368

288

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The pediatrician plays a major role in helping optimize bone health in children and adolescents. This clinical report reviews normal bone acquisition in infants, children, and adolescents and discusses factors affecting bone health in this age group. Previous recommended daily allowances for calcium and vitamin D are updated, and clinical guidance is provided regarding weight-bearing activities and recommendations for calcium and vitamin D intake and supplementation. Routine calcium supplementation is not recommended for healthy children and adolescents, but increased dietary intake to meet daily requirements is encouraged. The American Academy of Pediatrics endorses the higher recommended dietary allowances for vitamin D advised by the Institute of Medicine and supports testing for vitamin D deficiency in children and adolescents with conditions associated with increased bone fragility. Universal screening for vitamin D deficiency is not routinely recommended in healthy children or in children with dark skin or obesity because there is insufficient evidence of the cost–benefit of such a practice in reducing fracture risk. The preferred test to assess bone health is dual-energy x-ray absorptiometry, but caution is advised when interpreting results in children and adolescents who may not yet have achieved peak bone mass. For analyses, z scores should be used instead of T scores, and corrections should be made for size. Office-based strategies for the pediatrician to optimize bone health are provided. This clinical report has been endorsed by American Bone Health.

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Section: Assessment Of Bone Healthmentioning

confidence: 99%

Optimizing Bone Health in Children and Adolescents

Daniels¹,

Abrams²,

Corkins³

et al. 2014

Pediatrics

368

288

View full text Add to dashboard Cite

show abstract

“…10,26 In studies in otherwise healthy youth, children with a history of fracture have been shown to have reduced spine or whole-body bone mass or smaller bone area for height. 4,26 One study showed diminished bone density (by DXA) and bone strength (by HR-pQCT) in women and men who sustained a mild trauma distal forearm fracture during childhood. 27 Less is known about the relationship between low bone mass and fracture risk in children with chronic illness, because studies in these patient populations have been limited to smaller cohorts with varying diagnoses and risk factors for poor bone health.…”

Section: Ability Of Bone Densitometry To Predict Fracturesmentioning

confidence: 99%

“…2 -5 Children with forearm fractures have been shown to have lower bone mass, a greater percentage of body fat, and less calcium intake than their peers without a history of fracture. 3,4 The documented increase of 35% to 65% in childhood fractures over the past 4 decades has raised concern that current lifestyles are compromising early bone health. 5 Vitamin D insufficiency and deficiency are widespread, calcium intake often falls below recommended levels, and physical inactivity is common among American youth, all of which may increase a child's fracture risk.…”

Section: Introductionmentioning

confidence: 99%

Bone Densitometry in Children and Adolescents

Bachrach¹,

Gordon²,

Sills³

et al. 2016

Pediatrics

137

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Concerns about bone health and potential fragility in children and adolescents have led to a high interest in bone densitometry. Pediatric patients with genetic and acquired chronic diseases, immobility, and inadequate nutrition may fail to achieve expected gains in bone size, mass, and strength, leaving them vulnerable to fracture. In older adults, bone densitometry has been shown to predict fracture risk and reflect response to therapy. The role of densitometry in the management of children at risk of bone fragility is less clear. This clinical report summarizes current knowledge about bone densitometry in the pediatric population, including indications for its use, interpretation of results, and risks and costs. The report emphasizes updated consensus statements generated at the 2013 Pediatric Position Development Conference of the International Society of Clinical Densitometry by an international panel of bone experts. Some of these recommendations are evidence-based, whereas others reflect expert opinion, because data are sparse on many topics. The statements from this and other expert panels provide general guidance to the pediatrician, but decisions about ordering and interpreting bone densitometry still require clinical judgment. The interpretation of bone densitometry results in children differs from that in older adults. The terms “osteopenia” and “osteoporosis” based on bone densitometry findings alone should not be used in younger patients; instead, bone mineral content or density that falls >2 SDs below expected is labeled “low for age.” Pediatric osteoporosis is defined by the Pediatric Position Development Conference by using 1 of the following criteria: ≥1 vertebral fractures occurring in the absence of local disease or high-energy trauma (without or with densitometry measurements) or low bone density for age and a significant fracture history (defined as ≥2 long bone fractures before 10 years of age or ≥3 long bone fractures before 19 years of age). Ongoing research will help define the indications and best methods for assessing bone strength in children and the clinical factors that contribute to fracture risk. The Pediatric Endocrine Society affirms the educational value of this publication.

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“…(2,5,7,8) Altogether, 16% to 25% of pediatric patients treated for an acute fracture present with a history of a preceding fracture. (1,5,6) In children, fractures have been reported to associate with low bone mineral density (BMD) (9,10) and certain lifestyle factors, including low calcium intake, (11) poor vitamin D status, (12) and low as well as high physical activity. (13,14) Overweight children are prone to injuries and fractures, (15,16) while normal body fat content seems to be beneficial for bone health.…”

Section: Introductionmentioning

confidence: 99%

Impaired bone health and asymptomatic vertebral compressions in fracture-prone children: A case-control study

Mäyränpää

Viljakainen

Toiviainen-Salo

et al. 2012

Journal of Bone and Mineral Research

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Frequent fractures in children may be a sign of impaired bone health, but it remains unestablished when and how fracture‐prone children should be assessed. This prospective study elucidated skeletal characteristics and predisposing factors in children with recurrent fractures. Findings were used to establish guidelines for screening. During a 12‐month period we recorded fracture history for all children (n = 1412) treated for an acute fracture at a large university hospital. All apparently healthy children over 4 years of age, who had sustained: (1) at least one vertebral fracture; (2) two long‐bone fractures before age 10 years; or (3) three long‐bone fractures before age 16 years, were recruited. They underwent dual‐energy X‐ray absorptiometry (DXA), laboratory tests, and spinal radiography. Information regarding family history and lifestyle factors were collected. Findings were compared with healthy controls. Sixty‐six fracture‐prone children (44 males, mean age 10.7 years; 5% of all children with fractures) were identified. Altogether, they had sustained 183 long‐bone fractures (median 3, range 0–7); 11 children had sustained vertebral fracture(s). Patients had significantly lower bone mineral density (BMD) at lumbar spine (p < 0.001), hip (p = 0.007), and whole body (p < 0.001) than the controls; only 5 children (8%) had a BMD Z‐score < −2.0. Asymptomatic vertebral compressions were prevalent, especially in those under 10 years of age. Hypercalciuria (11%) and hyperphosphaturia (22%) were significantly more prevalent than in controls. Serum concentration of 25‐hydroxyvitamin D (S‐25OHD) was below 50 nmol/L in 55%; low levels were associated with low BMD and vertebral compressions. The fracture‐prone children had lower calcium intake, less physical activity, and more often had siblings with fractures than the controls. The findings suggest that a thorough pediatric evaluation, including DXA and spinal radiography, is often indicated already after a second significant low‐energy fracture in children, in order to detect potentially preventable adverse lifestyle factors and nutritional deficits and to identify those with compromised overall bone health. © 2012 American Society for Bone and Mineral Research.

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Association Between Bone Mass and Fractures in Children: A Prospective Cohort Study

Cited by 321 publications

References 31 publications

Optimizing Bone Health in Children and Adolescents

Optimizing Bone Health in Children and Adolescents

Bone Densitometry in Children and Adolescents

Impaired bone health and asymptomatic vertebral compressions in fracture-prone children: A case-control study

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