title: The Child with Multiple Fractures, What Next?
abstract: Fractures are common during childhood; however, they can also be the presenting symptom of primary or secondary causes of bone fragility. The challenge is to identify those children who warrant further investigation. In children who present with multiple fractures that are not commonly associated with mild to moderate trauma or whose fracture count is greater than what is typically seen for their age, an initial evaluation, including history, physical examination, biochemistry, and spinal radiography, should be performed. In children with bone pain or evidence of more significant bone fragility, referral for specialist evaluation and consideration of pharmacologic treatment may be warranted.
authors.affiliation: Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G1X8, Canada. Electronic address: jennifer.harrington@sickkids.ca.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Harrington
authors.affiliation: Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, Ontario M5G1X8, Canada.
authors.forename: Etienne
authors.initials: E
authors.lastname: Sochett
mesh_terms: D000293:Adolescent; D015519:Bone Density; D002136:Calcium, Dietary / Q000008:administration & dosage; D002648:Child; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D012307:Risk Factors; D012737:Sex Factors; D014807:Vitamin D / Q000008:administration & dosage; D016474:Weight-Bearing; D055815:Young Adult
chemical_list: D002136:Calcium, Dietary; D014807:Vitamin D
keywords: Bone mineral density; Children; Fractures; Osteogenesis imperfecta; Osteoporosis