Bone Abstracts

Fractures are common in childhood, but multiple fractures during growth could indicate osteoporosis. Children with frequent fractures might benefit from further investigations for osteoporosis and as such, obtaining an accurate fracture history is important. The 2013 International Society for Clinical Densitometry Paediatric Osteoporosis Position Statement defined a clinically significant fracture history as two long bone fractures before age 10 years or three long bone fractures before 19 years of age, excluding fractures caused by high impact mechanisms. The accuracy of parental recall of their child’s lifetime fractures has not previously been evaluated. We therefore assessed whether parental recall of lifetime fracture were in agreement with radiological reports obtained at the time of injury.

Parents of children (<18 years) attending the paediatric orthopaedic clinic following an acute musculoskeletal injury were invited to complete a written questionnaire on their child’s fracture history, including age, site and mechanism of each previous fracture. Hospital records were reviewed to determine whether a fracture had been confirmed radiologically.

207 of 660 children (66% male, median age 11.8 years, range 1.2–17.3 years) reported a previous fracture (range 1–7). An injury treated at our hospital was identified in 214 of the 276 reported fractures, of which 34 (16%) had not resulted in a radiograph confirmed fracture. This was similar for reported upper (15%) and lower limb (20%) fractures (P=0.51).

For 150 children, all previously reported fracture episodes were managed at our hospital. Of these, 18 had a clinically significant lifetime fracture history on parental report alone. For two children (11%), the fracture histories were no longer considered clinically significant after review of radiology reports.

Approximately one in six previous fractures reported by parents to have occurred in their child’s lifetime, had not resulted in a confirmed skeletal injury. Of those with an apparent clinically significant fracture history, one in nine children could have been investigated unnecessarily (e.g. vertebral radiographs, densitometry and/or blood sampling) when using only parental fracture reports. Parental recall of lifetime fracture history should be corroborated with radiological confirmation of skeletal injuries before undertaking extensive investigations for bone fragility in children.

Disclosure: The authors declared no competing interests.