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Screening Infants at Risk for Fractures — Child Risk Factors for Metabolic Bone Disease, Osteopenia and Fractures — Clinical Pathway: Inpatient

Screening Infants and Children at Risk for Fractures Clinical Pathway — Inpatient

Child Risk Factors for Metabolic Bone Disease, Osteopenia and Fractures

Child Condition/Treatment Rationale
Non-ambulatory Status or Recent Significant Decrease in Ambulatory Status or Weightbearing Activity Chronic muscle weakness and diminished weight bearing weaken bones because of impaired bone density and strength accrual. Acute loss of weight bearing leads to frank loss of bone mineral due to an imbalance of bone resorption and formation.
Parenteral Nutrition (PN) > 4 wks Difficult to provide adequate mineral intake from PN regimens to meet demands of growing skeleton.
Systemic (IV/PO) Steroids > 14 days Acute initiation of high dose steroids for >14 days weakens bones due to increased bone resorption. Vertebral fractures can occur as soon as 30 days following onset of treatment. Chronic steroid exposure weakens bone through suppressed bone formation leading to impaired accrual of bone density and strength.
Severe Neuromuscular Disease
  • These conditions are all associated with diminished muscle strength and weight bearing as discussed above
  • Most individuals with Duchenne muscular dystrophy are treated with chronic high dose steroids
Osteopenia, Demineralization, or
“Gracile Bones” Reported on Radiograph		 These findings suggest impaired accrual of bone density and strength.
Loop Diuretic Use > 14 Days These medications lead to urinary wasting of calcium that can contribute to secondary hyperparathyroidism and/or impaired bone mineral accrual.
Disorders Resulting in Malabsorption
  • Short Bowel Syndrome (SBS)
  • Lymphatic dysfunction
  • Cystic Fibrosis
  • GI disorders such as IBD
  • Altered GI function and malabsorption may contribute to metabolic bone disease.
  • Often leads to prolonged parenteral nutrition requirement. See PN rationale.
Restrictive Diets Restrictive diets due to multiple food allergies, autism or disordered eating can result in inadequate nutrient intake, contributing to metabolic bone disease.

Primary Bone Disorders

  • Osteogenesis imperfecta
  • Genetic vitamin D disorders
  • Hypophosphatasia
  • Osteopetrosis