SickKids study shows one childhood fracture can lead to another; offers important insights into bone health and lifelong outcomes

Most kids fall and hit the ground from time to time, but not all children and youth break an arm or leg when they do. About half of boys and one third of girls in North America will break a bone during their childhood.

In the first study of its kind, researchers at The Hospital for Sick Children (SickKids) investigated whether having one childhood fracture leads to another. They discovered that children who fracture once are more likely than their peers to fracture again. The study was published on July 15 in Pediatrics.

“To date, no research has looked into whether having one fracture predisposes children and youth to have another. This information is readily available in older adults, but not in children,” says Dr. Andrew Howard, Interim Head of the Division of Orthopaedics and Senior Scientist at SickKids. “In our study, we found compelling evidence that one childhood fracture predicts a subsequent fracture and also offers critical information about bone health in the paediatric population.”

Researchers followed a group of 43,000 children in Ontario who had fractured bones over a period of seven years, and compared them with 2.4 million children who did not have a fracture. They discovered that the risk of a fracture was 60 per cent higher for children who have suffered a previous fracture. They also found that children with one or multiple fractures typically have certain identifying risk factors that predispose them to subsequent fractures.

“Our study suggests that having one or more fractures may indicate poor bone strength in children. This may be due to low physical activity levels, poor nutrition, and even rising rates of childhood obesity,” says Howard. “The good news is that there are many ways that kids’ bones can be strengthened and the risk of fracture can be reduced, including plenty of weight-bearing exercise, adequate dietary protein and calcium, and vitamin D supplementation. Parents can help their children to adopt these bone-friendly lifestyle habits.”

Childhood fracture risk is a dynamic phenomenon with biological, behavioural, and environmental factors to consider. Some of these factors – like an individual’s genes – are stable. However, the remaining factors – exercise, diet, and lifestyle – can be modified to maximize bone mass, improve long-term bone health outcomes, and reduce fracture risk.

“Improving childhood bone health may decrease the risk of osteoporosis and fractures in later life, because the majority of bone development occurs during childhood and adolescence,” says Howard. “Children who sustain a fracture, and their parents, should be educated about their increased risk of future fractures and ways to improve bone health.  

Current study findings also provide important guidance for clinicians and researchers in designing interventions to prevent childhood fractures, and potentially improve lifelong bone strength.

This study was supported by a joint Ontario Ministry of Health and Long-Term Care and University of Toronto Clinician Investigator Program support grant. It received nonfinancial support from the Institute for Clinical Evaluative Sciences, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care.