image of girl wearing a cast on her arm

Bone Fractures in Children: When Should Parents Be Concerned?

As kids play hard, or engage in vigorous or high-speed physical activities like biking or skateboarding, they may fall hard and break a bone. Broken bones or fractures are common in childhood, with up to 40 percent of girls and as many as 50 percent of boys experiencing a fracture.

Fracture rate peaks from 11-15 years of age, the time when children have a pubertal growth spurt and the amount of minerals needed to keep bones strong often can’t keep up with how fast the bones are growing. Forearm fractures are the most common fractures in children, responsible for up to 50 percent of all fractures, and are much more common than leg fractures. This is because it is a common reflex to throw out your arms to catch yourself when you fall.

When are bone fractures cause for concern?  

There is usually no cause for concern in a vast majority of childhood fractures as they heal quickly after a cast. Some fractures may need to be fixed by an orthopedic specialist to improve the alignment of the bones. However, children who experience certain types of fractures, particularly those from seemingly mild injuries, or have multiple fractures, may need to be evaluated by a pediatric metabolic bone specialist.

There are also genetic bone disorders or underlying medical conditions that can cause bone fragility in kids, making them more prone to fractures. These medical conditions or bone disorders can be treated to improve bone strength and prevent risk. The types of fractures that would warrant an evaluation by a metabolic bone specialist include:

  1. Low-impact fractures or fragility fractures. Children may have pathological fractures, which are bone breaks that do not occur in healthy and strong bones, but in weakened bones. These fractures may signal underlying metabolic bone disorders. They are often the result of a minor injury, such as falling from a standing height or lower, falling off a chair, or occuring during routine activity (such as stepping off a curb).
  2. Humerus or femur fractures. These two long bones are strong and usually do not break easily unless the injury is severe (such as a car accident). Having these two long bone fractures may be a sign of metabolic bone disease.
  3. Recurrent fractures. If your child has two or more fractures before age 10, or three or more fractures before age 19, you may want to consider having your child evaluated.
  4. Vertebral compression fractures. Unless there is a significant trauma to the back, having one or more vertebral compression fractures is a sign of osteoporosis, or a metabolic bone disease.

If your child has any of the above bone fractures, consult your child’s doctor or ask for a referral to the Metabolic Bone Clinic at Nationwide Children’s Hospital.

Sasigarn Bowden, MD
Sasigarn Bowden, MD, is a pediatric endocrinologist in the Division of Pediatric Endocrinology, Metabolism and Diabetes at Nationwide Children’s Hospital and an Associate Professor of Clinical Pediatrics at The Ohio State University College of Medicine. Dr. Bowden received her medical degree from Chiang Mai University, Thailand. She completed her pediatric internship and residency at Prince of Songkla University, Songkla, Thailand, and a pediatric residency at the University of Tennessee Graduate School of Medicine in Knoxville, Tennessee. Dr. Bowden completed her pediatric endocrinology fellowship training at Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio. Dr. Bowden is board certified by the American Board of Pediatrics (ABP) and ABP Sub-Board of Pediatric Endocrinology. Her clinical and research interests include calcium/metabolic bone disorders, pediatric osteoporosis, growth and diabetes mellitus. She is the associate program director for the fellowship program and also a member of the physician team for the Metabolic Bone Clinic and the Neuromuscular Disorders section of The Neurosciences Center at Nationwide Children’s Hospital. Administratively, she serves on the Medical Student Educational Liaison Committee, and as the physician coordinator/organizer for the continuing medical education in the division.

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