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Putting on the Breaks When It Comes to Recurrent Fractures :

July 19, 2019

When a child experiences a bone fracture, are they at increased risk for a subsequent fracture?

When a child experiences a bone fracture, are they at increased risk for a subsequent fracture? This is the question that Howard et al. (10.1542/peds.2017-2552) decided to answer with a new study being released this week in our journal.  The authors went into the study thinking there would be no increase in recurrent fractures after a first fracture.  They tested this hypothesis in a little over 43,000 children in Ontario who had a fracture in the first year of this population-based retrospective cohort of 2.5 million children between 0 and 15 years who were then followed for 7 years.  The surprising results are that there was a 60% higher rate of fracture (23% versus 11.3 %) even when adjusting for key confounders.

What can we do about this?  We asked pediatric endocrinologist Dr. Laura Bachrach to share her thoughts with us in an accompanying commentary (10.1542/peds.2019-1594).  Dr. Bachrach points out that increased risk-taking by these children is not the reason for the higher rate of recurrent fractures—or at least not the sole reason.  Instead she notes that these children could have metabolic factors that would predispose them to increased bone fragility and in turn the increased recurrence risk of a fracture.  She cites studies to back up her rationale which are quite interesting to read about. Given that there may be a metabolic predisposition to breaking a bone, should all first fractures receive a metabolic bone workup?  Dr. Bachrach suggests we consider the location of the fracture and the extent of trauma that caused it as the guide to how much of a metabolic bone workup we do—if you are not convinced that the extent of trauma should have caused the degree of fracture, do the work up. To find out what that workup entails, as well as to remind ourselves of what we need to stress to patients for healthy bone growth, check out this commentary along with the study that triggered Dr. Bachrach to write it.  Make no bones about these two papers—they are well worth taking a break and reading to learn more.

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