Childhood fractures: Time to implement strategies to reduce these events

Most children complete growth without breaking any bone, suggesting healthy skeletons should remain intact and sustain the trauma associated with normal sport and play. Unfortunately, paediatric fractures are quite common and are currently increasing. Some apparently healthy children have substantially higher risks for fracture than others. Thus, two-thirds of all fractures in childhood and adolescence occur in youngsters who break bones repeatedly, and these children often experience their first fracture before they are teenagers. Children with distal forearm fractures have lower bone mineral content and density than age- and sex-matched controls with no fractures. Prospective studies show that previous fractures, low bone mineral density and high body weight are independent risk factors for further fracture during growth. Young milk avoiders who make no compensatory dietary substitutions have poor skeletons and an increased fracture risk. Balanced nutrition and regular weight-bearing exercise are needed to optimise bone growth. Because well-designed randomised control trials have shown that increasing calcium, milk supplementation and weight-bearing activity will augment bone mineral gain during growth in general populations, it seems that the time has come to evaluate the ability of these measures to reduce rates of new fracture in children who have already shown bone weakness by experiencing a fracture.