Bone Health in Adolescents with Multiple Fractures

Multiple fractures can be a common occurrence in adolescence, especially in the active teenager. It is important to understand what is considered abnormal, the work-up for abnormal fractures, the mechanism of fracture healing, and the risk factors for re-fracture. A differential diagnosis is presented for abnormal fractures in the adolescent patient. Abnormal fractures are defined as two or more long bone fractures by age 10, three of more long bone fractures by age 19, or one or more vertebral compression fractures with greater than 20% vertebral height loss in the absence of local disease or severe trauma. The work-up includes a thorough history and physical exam, laboratory testing, and baseline imaging. The imaging should include a standing lateral spine radiograph and a determination of bone mineral density. Risks for re-fracture include inadequate immobilization, incomplete bony union, inadequate reduction, middle or proximal one-third forearm fractures, age, and level of activity.