Pathologic Fractures in Children
Fractures are a common occurrence in children. In fact, 42% of all boys and 27% of all girls will sustain at least one fracture by the time they reach the age of 16. Causes of these fractures vary by age as the reasons for injury differ as a child matures. For example, an infant is likely to be injured from a low energy fall at home, while the adolescent is more likely to be injured due to a sports injury or a motor vehicle collision.
Understanding Bone Structure:
Bone is made of two components: collagen and mineral. Collagen is a strong protein material that provides its strength and prevents the bone from being pulled apart. The mineral part is mostly made of calcium and phosphate. This mineral substance provides the bone its strength and protects the bone against compression.
Bone stores 99% of the body's calcium and calcium is required for other systems in the body. If the body does not have enough calcium from the diet, then the body will take calcium from the bone so the body continues to function normally.
Vitamin D is a hormone that performs numerous vital functions in the body. With respect to maintaining bone health, it enables the intestines to absorb calcium from the diet into the bloodstream. Therefore if there is enough vitamin D in the diet, there will be no need to pull from the reserves in the bone.
Recommended Daily Allowances:
It is important to get proper amounts of calcium and vitamin D in the diet. Calcium deficiency is a widespread problem in adolescents. Vitamin D deficiency is even more common, often occurring as a result of a diet that lacks Vitamin D fortified food or in someone that is dark-skinned with minimum sun exposure.
During the adolescent growth spurt, the rate of bone growth is faster than the rate the body can mineralize it. So between the less mineralized bone and the more "risky" adolescent behaviors, this is a time period when teens are very susceptible to fracture. Therefore, it is extremely important to ensure that adolescents consume proper levels of calcium and vitamin D.
|Daily Requirements of Calcium||Daily Requirements of Vitamin D|
|Infants: 600 mg/day||Breastfed Infants: require supplementation after first few days of life|
|Children: 800-1200 mg/day||Breastfed Infants: require supplementation after two months|
|Adolescents: 1200-1500 mg/day||Formula-Exclusive Infants: no supplementation needed|
|-||Mix Breast Feeding/Formula: require supplementation|
|-||Older Children: often require supplementation|
While fractures may be an inevitable and "normal" part of childhood, there are certain times in which fractures are "pathologic." This is the term that orthopedists use for a fracture that occurs through abnormal bone.
Classically, the fracture occurs during normal activity or after minor trauma. For example, a child who breaks his tibia after being tackled playing soccer is likely to fracture through "normal bone," while a child who breaks his femur after a fall from a very short height is suspicious for a fracture through abnormal bone.
Bone is abnormal due to a collagen problem or a mineral problem. Most disorders are due to a collagen problem caused by one of the following:
- A disease like osteogenesis imperfecta (OI) in which the collagen itself is either abnormal or the quantity is insufficient.
- A benign tumor which replaces the bone
- Fibrous dysplasia
- Unicameral bone cysts
- Aneurysmal bone cysts
- Nonossifying fibroma
- Giant cell tumors
- A malignant tumor that replaces the bone
- Scurvy (Vitamin C Deficiency)
- An infection that destroys the bone
Other times the disorder can be caused by abnormal bone mineral
- Nutritional deficiency
- Anti-seizure medications
- Anti-psychotic medications