PDF Bone Health Assessment in Pediatrics: Guidelines for Clinical Practice

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Child abuse is far more common than bone disorders. Nevertheless, the clinician must consider the possibility of pre-existing medical conditions associated with bone fragility, and radiographic abnormalities must be interpreted carefully to avoid misinterpretation Figure 2 [5][6][8]. The history should include all recent and remote traumatic events and any known medical conditions.

Document prior and current medication use, including vitamin supplements, notably vitamin D.


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Growth and developmental milestones, particularly gross motor abilities, may be helpful in evaluating the plausibility of reported injury mechanisms. The family history should include consanguinity, known metabolic abnormalities, fractures in related family members, hearing impairment, connective tissue disorders and dental hypoplasia.

Any infant or child presenting with a skeletal injury of unclear cause must have a thorough physical examination. Documentation should include:. Ask for an indirect ophthalmological examination by an ophthalmologist in all children with a head injury concerning for inflicted trauma. If the child has evidence of multisystem trauma or concern for an underlying medical condition, additional medical testing may be indicated [5][6].

The skeletal survey SS is the cornerstone of radiographic investigation for fractures of unclear cause because it provides valuable information about bone health and may identify occult skeletal injury. While the yield for positive findings decreases past age 2 years, the clinician should consider imaging children between 2 and 5 years of age when there is a strong likelihood of occult inflicted injury. Guidelines for appropriate SS imaging in children are outlined by the American College of Radiology and endorsed by the American Academy of Pediatrics [23][24].

The SS must be performed in a complete and technically adequate manner to optimize identification of both underlying medical conditions and skeletal injuries that are not clinically evident e. A bone scan may be helpful when used in conjunction with the skeletal survey.

However, due to poor sensitivity for metaphyseal, epiphyseal and skull fractures, a bone scan alone should not be used for diagnosis [6].

Review of skeletal imaging by a paediatric radiologist is recommended. While not all skeletal injuries discovered on radiographic imaging require medical intervention, they may be important for determining injury cause. If the initial SS is negative or equivocal and maltreatment remains a concern, a follow-up SS should be conducted approximately 2 weeks later [6][23]. In the case of a positive initial SS, follow-up images may identify additional injuries and contribute valuable information on healing and timing of injury. Consider omitting images of the skull, pelvis and lateral spine in follow-up studies, because injuries to these areas are typically identified on the initial series and eliminating them later reduces radiation exposure [25][26].

Consider neuroimaging for all infants presenting with fractures and suspected maltreatment. Additional imaging studies may be indicated when laboratory evaluation raises concern for abdominal injury.

Introduction

Healing of musculoskeletal injuries occurs on a continuum, generally with a predictable progression of radiographic signs in young children. Findings include soft-tissue swelling, periosteal reaction, callus formation and remodelling. Estimating the age of skeletal trauma is important for identifying inconsistencies in the presenting history related to injuries found on physical examination or radiologic studies.

introduction

Time frames for dating long bone fractures are broad and demonstrate significant overlap [27]. The presence of fractures of different ages suggests multiple injury events at different times. The documentation of all historical and clinical information should be detailed, using clear, objective language and conclusions. When the clinical, radiographic or laboratory information suggests a pre-existing medical condition, a consult with genetics, metabolic diseases or endocrinology may be particularly helpful Figure 2.

An orthopedic consultation is often necessary to assist with fracture immobilization, surgical management or concerns regarding suboptimal healing or growth. Any reasonable suspicion of child maltreatment requires reporting to the appropriate child protection authorities, in all provinces and territories in Canada. Consultation with clinicians who have expertise in child maltreatment paediatrics can assist medical management, facilitate collaboration between health care providers and community child protection investigators, and help with medico-legal aspects of communication and documentation.

The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone ;17 suppl S Population-based study of survival after osteoporotic fractures. Am J Epidemiol ; Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet ; Medical expenditures for the treatment of osteoporotic fractures in the United States in Report from the national osteoporosis foundation.

Bone Mass in Children and Adolescents

J Bone Miner Res ; Bone Health and Osteoporosis. A Report of the Surgeon General. Physician's guide to prevention and treatment of osteoporosis.

Age-related reductions in the strength of the femur tested in a fall-loading configuration. J Bone Joint Surg Am ;77 3 J Biomechan Eng ; Enhanced precision with dual-energy X-ray absorptiometry. Calcif Tissue Int ;51 1 Radiation exposure in bone mineral density assessment. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ ; Systematic reviews of randomized trials in osteoporosis: Introduction and methodology.

Endocr Rev ;23 4 Antifracture efficacy of antiresorptive agents are related to changes in bone density. J Clin Endocrinol Metab ;85 1 World Health Organization. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Geneva, Switzerland: WHO; Guglielmi G, Lang TF.

Osteoporosis

Quantitative computed tomography. Semin Musculoskelet Radiol ;6 3 Volumetric quantitative computed tomography of the proximal femur: precision and relation to bone strength. Bone ;21 1 What are the standards by which bone mass measurement at peripheral skeletal sites should be used in the diagnosis of osteoporosis?

J Clin Densitom ;5 suppl :SS Which central dual X-ray absorptiometry skeletal sites and regions of interest should be used to determine the diagnosis of osteoporosis? J Clin Densitom ;5 suppl :S American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: edition, with selected updates for Endocr Pract ; 9 6 Indications and reporting for dual-energy X-ray absorptiometry. J Clin Densitom ;7 1 Management of postmenopausal osteoporosis: position statement of the North American Menopause Society.

Menopause ;9 2 Osteoporosis prevention, diagnosis, and therapy. JAMA ; 6 Screening for osteoporosis in postmenopausal women: Recommendations and rationale. Ann Intern Med ; 6 Sociedade Brasileira de Densitometria. Arthritis Rheum ;S Updated data on proximal femur bone mineral levels of US adults. Osteoporos Int ;8 5 Introduction, methods, and participants. Bilateral comparison of femoral bone density and hip axis length from single and fan beam DXA scans. Calcif Tissue Int ;56 1 Diagnosis of osteoporosis in men, premenopausal women, and children.

Biomechanics of osteoporosis and vertebral fracture.

Public Archives - International Society for Clinical Densitometry (ISCD)

Spine ;22 suppl SS. Differences in proximal femur geometry distinguish vertebral from femoral neck fractures in osteoporotic women. Br J Radiol ;77 Heaney RP. Pathophysiology of osteoporosis. Endocrinol Metab Clin North Am ;27 2 Regional differences in cortical porosity in the fractured femoral neck. Bone ;24 1 Burr D. Microdamage and bone strength. Osteoporos Int ;14 suppl 5 :SS Connect Tissue Res ;4 Delmas PD.

How does antiresorptive therapy decrease the risk of fracture in women with osteoporosis? Bone ;27 1 Boskey A. Bone mineral crystal size. Osteoporosis considerations in the frail elderly. Curr Opin Rheum ;15 4 Vitamin D status, trunk muscle strength, body sway, falls, and fractures among postmenopausal women with osteoporosis. Exp Clin Endocrinol Diabetes ; 2 Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med ; 12 Risk factors for incident vertebral fractures in men and women: the Rotterdam Study.

CPG Infobase: Clinical Practice Guidelines

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