Enhanced Diet, Physical Exam Prove Best Medicine For Children With Frequent Fractures

While fractures may be on the rise in
U.S. children, bone mineral density tests are unnecessary for most children
who experience repeat fractures. Although recent research shows a correlation
between recurrent fractures during childhood and decreased bone mineral
density, parents can be assured that the safest and most accurate way to
identify any concerns regarding a child's bone mineral density level is
through regular physical exams and an assessment of the child's dietary
history. This is according to new research findings presented at the 73rd
Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS). The
study addressed the issue of frequent fractures in children, particularly how
to best assess bone mineral density levels and prevent initial and subsequent
fractures.


Bone mineral density (BMD) in healthy children increases with age until
peaking in early adulthood. Reaching optimal peak bone mineral mass is the
best way to prevent osteoporosis -- the brittle bone disease posing a public
health threat for 34 million Americans, according to the U.S. Surgeon General
-- later in life. Children with low BMD have bones with less than optimal
amounts of calcium and other minerals that make them strong. As a result,
these children's bones are more susceptible to fractures.


John M. Mazur, MD, pediatric orthopaedic surgeon at the Nemours Children's
Clinic, Jacksonville, Fla., and a team of researchers conducted a study to
determine if children with two or more incidences of fractures have low BMD.
The team also investigated whether BMD testing -- involving x-ray scanning --
is necessary for children with multiple incidences of bone fractures.


"Our findings show that children with several incidences of fractures do
not require bone mineral density testing," explained Dr. Mazur. "Children who
experience more than one fracture may indeed have decreased bone mineral
density compared to other children their age, but certainly not enough to
warrant additional x-ray testing or medical treatment."


BMD is most accurately measured by a technique called DEXA (dual energy
x-ray absorptiometry) scanning. DEXA scans require the patient to lie down
while the x-ray device passes over the spine, pelvic and hip area to assess
bone strength and health.


After the researchers reviewed DEXA scan results of 48 boys and 16
girls -- between the ages of 5 and 17 -- who experienced several fractures
revealed lower BMD levels, they found these patients were more likely to have
diminished BMD levels compared to peers in their same age and sex subset.
However, only one of the 64 patients had a BMD in what is considered the
"osteoporotic" range: a level not substantially lower than what is present in
children who have not experienced fractures.















Based on the study findings, DEXA scans should not be considered part of
routine screening in children with frequent fractures, Dr. Mazur stressed.
Instead, regular physical exams and an inventory of children's dietary intake
provide physicians with the information needed to determine whether further
treatment is required.


"Physician screening of young patients for calcium intake and bone health
should occur three times during childhood: at age 2 or 3 after weaning from
breast milk or formula, at 8 or 9 before the adolescent growth spurt, and
during the puberty or teen years when the peak rate of bone mass growth
occurs," explained Dr. Mazur. "Screening should include asking young patients
-- and their parents -- simple questions about diet, milk consumption, the
amount of exercise, bone fractures and any family history of osteoporosis."


While studies have shown the effectiveness of medications in treating
adults with osteoporosis, the safety and effectiveness of these drugs in
children remain largely unknown. Additionally, minimal research to date has
focused on treating or preventing osteoporosis in children. What is known,
however, is that poor nutrition -- including a low calcium diet -- low body
weight and a sedentary lifestyle, beginning in childhood, are risk factors for
osteoporosis.


Parents must also play a critical role in ensuring children adhere to
bone-maximizing behaviors. Reinforcing the importance of a calcium and vitamin
D-rich diet, coupled with regular daily exercise -- especially during
childhood and adolescence -- are critical ways to promote bone health,
according to Dr. Mazur.


Because osteoporosis is much easier to prevent than to treat, AAOS
suggests the following tips for promoting overall good bone health in
children:


-- Good bone health starts during childhood, with good habits like exercise
and diet. Bones, like muscles, need exercise to stay strong.


-- Strong bones support the body, are the framework for all muscles, and
protect the heart, lungs, brain, and other vital organs from injury.


-- Weight-bearing exercises like walking, dancing and jogging are best for
building and maintaining strong bones.


-- Exercise in children is usually as easy as promoting physical activities
and avoiding excessive sedentary activities, such as playing video games
and watching television.


-- Promote a diet with adequate daily amounts of calcium: children under
age one require 600 mg; 1-10 years of age require 1200 mg; and 10-24
years of age require 1500 mg.


-- Calcium-rich foods, many of which are also vitamin D supplemented --
such as yogurt, cheese, milk, sardines with bones, and green leafy
vegetables like broccoli and collard greens - may help prevent the onset
of osteoporosis.


The study was funded by the Nemours Clinical Management Program, the
Nemours Foundation, Jacksonville, Fla.


An orthopaedic surgeon is a physician with extensive training in the
diagnosis and non-surgical as well as surgical treatment of the
musculoskeletal system, including bones, joints, ligaments, tendons, muscles
and nerves.


With more than 29,000 members, the American Academy of Orthopaedic
Surgeons (aaos) or (orthoinfo) is the premier
not-for-profit organization that provides education programs for orthopaedic
surgeons and allied health professionals, champions the interests of patients
and advances the highest quality musculoskeletal health. Orthopaedic surgeons
and the Academy are the authoritative sources of information for patients and
the general public on musculoskeletal conditions, treatments and related
issues. An advocate for improved patient care, the Academy is participating in
the Bone and Joint Decade (usbjd) -- the global initiative in
the years 2002-2011 -- to raise awareness of musculoskeletal health, stimulate
research and improve people's quality of life. The Academy's Annual Meeting is
being held March 22-26, 2006 at McCormick Place in Chicago.


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