Implications of mild vs moderate trauma childhood distal forearm fractures for peak bone mass acquisition: The two faces of growth

Joshua Farr, Sundeep Khosla, Joseph Melton, Elizabeth Atkinson, Salman Kirmani, Louise McCready, Shreyasee Amin

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Growth is the most opportune period to modify bone structure. We recently found that children who sustain a distal forearm fracture (DFF) due to mild, but not moderate, trauma have cortical thinning and deficits in bone microarchitecture at the radius and tibia. However, whether these skeletal deficits track into adulthood is unknown. Therefore, we used HRpQCT to examine cortical and trabecular bone parameters at the distal radius and tibia in 150 subjects (75 women; 75 men), age 20–40 yrs, who had a childhood (,18 yrs) DFF and 150 sex- and age-matched non-fracture controls. None used medications, or had diseases, affecting bone metabolism. We used the Landin classification (Acta Orthop Scand 202:1, 1983) to assign trauma levels, blind to the bone imaging results. None had a severe trauma DFF (e.g., traffic accident).Adult women (Fig. A) and men (Fig. B) with a mild trauma (e.g., fall from standing height) DFF in childhood had significant deficits in cortical area (–10.2%and –9.2%, respectively; P,0.05) at the radius as compared to controls. Women with a mild trauma DFF in childhood also had significantly lower cortical volumetric BMD (vBMD, –1.7%; P=0.002), whereas men with a mild trauma DFF in childhood had significantly lower trabecular bone volume fraction (BV/TV, –9.0%; P=0.008)compared to controls. By contrast, adult women and men with a moderate trauma(e.g., sport-related collision) DFF in childhood both had higher radial cortical areas as compared to controls, although only the difference in men was statistically significant (+8.6%; P=0.041). Importantly, skeletal deficits in the mild trauma DFF cases were generalized, as these subjects tended to have similar changes at the tibia, as well as significantly lower DXA-derived areal BMD at the radius, lumbar spine, hip and total body regions as compared to their controls (all P,0.05).In conclusion, a mild trauma DFF during childhood presages deficits in bone structure and density in adulthood. By contrast, as hypothesized by Parfitt (‘‘The Two Faces of Growth: Benefits and Risks to Bone Integrity’’, Osteoporos Int 4:382, 1994),children who suffer a moderate trauma DFF may be paying the price of risk-taking behaviors (e.g., sports) in childhood that optimize cortical bone structure during growth. Therefore, children with a mild trauma DFF should be identified and targeted for lifestyle interventions that encourage achievement of their full skeletal genetic potential.

Original languageUndefined/Unknown
JournalDepartment of Paediatrics and Child Health
Publication statusPublished - 1 Feb 2013

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