She is an otherwise healthy girl, previously very athletic, with normal puberty. She was seen by a hematologist who performed a bone marrow biopsy of T6, which was normal. Two additional thoracic vertebral fractures soon followed. At age 10 ¾, she fractured T3 playing sports, and at age 11 ½, she fractured T5 playing laser tag. She was evaluated by an orthopedist who instructed her to resume her regular activities, including lacrosse and basketball. At age 10, she fractured T6 while riding a roller coaster. Ī 12-yr-old girl presents with a history of multiple vertebral compression fractures. If you have questions about this CME activity, please direct them to. The estimated time to complete this activity, including review of material, is 1 hour. To receive CME credit, participants should review the learning objectives and disclosure information read the article and reflect on its content then go to and find the article, click on CME for Readers, and follow the instructions to access and complete the post-activity test questions and evaluation. This Journal-based CME activity is available in print and online as full text HTML and as a PDF that can be viewed and/or printed using Adobe Acrobat Reader. Close monitoring is required, and further study is necessary to assess their long-term safety and efficacy in children. ![]() The use of bisphosphonates in children and adolescents is controversial due to lack of long-term efficacy and safety data and should be limited to clinical trials and compassionate therapy in children with significantly compromised quality of life. ![]() Conservative measures including calcium and vitamin D supplementation and weight-bearing physical activity are important interventions that should not be overlooked. Given the skeleton's ability to recover from low BMD through modeling and remodeling, optimizing management of underlying conditions leading to bone fragility is the initial step. Interpretation of pediatric dual-energy x-ray absorptiometry should be based on Z-scores ( sd scores compared to age, sex, and ethnicity-matched controls), using normative databases specific to the brand of densitometer and the patient population. ![]() Interpretation of bone densitometry in growing patients presents a unique set of challenges because areal BMD measured by dual-energy x-ray absorptiometry depends on multiple dynamic variables. There is no “gold standard” for the evaluation and treatment of children with fractures and low bone mineral density (BMD) therefore, the diagnosis of osteoporosis in a pediatric patient should be made using a combination of clinical and radiographic features. Although most fractures in childhood are benign, recurrent fractures may be associated with a wide variety of primary skeletal diseases as well as secondary causes, necessitating a careful history and physical exam to guide the evaluation. Evaluation of the child with fractures is challenging, as no clear guidelines exist to distinguish traumatic from pathological fractures.
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