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Your child’s primary physician can assess and order x-rays if there is concern for a bone fracture. A complex care clinician and dietician can monitor electrolyte and vitamin levels in the blood. A physical therapist or physical medicine and rehabilitation specialist can develop a weight-bearing program and recommend equipment. An endocrinologist can discuss medication treatment of osteoporosis if a fragility fracture occurs. An orthopedist manages the treatment of fractures.
Osteoporosis and Fractures
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Children with limited ability to walk are at risk for developing low bone mineral density, or osteoporosis. Osteoporosis is a condition in which bones become weak and brittle, which increases the risk of fractures. Children with SNI are at particular risk for fragility fractures, which are fractures that can easily occur with minimal or no known trauma.
ESP Understanding Risks
Osteoporosis puts your child at risk for fragility fractures, which are bone fractures that occur in the absence of obvious trauma, or with minimal trauma from normal activities of daily living. This means that there does not have to be an accident or known cause. You can ask physical therapists for techniques that decrease fragility fracture risk. These include safe ways to put on clothes and shoes to avoid twisting of limbs, and safe ways to transfer your child from bed to chair and back. These techniques will also lessen the risk of your own injury from these daily tasks. As your child grows, you can ask about equipment options like patient lifts (e.g., Hoyer Lift) for the home, though this may not work in all homes.
Prevention
Weight-bearing and time in an upright position provides stimulation to bones. This helps maintain bone density and lessens the chance of developing osteoporosis. Standing and walking are the ways in which we naturally bear weight. If your child is unable to support their own weight to stand or walk, physical therapists, physical and rehabilitation specialists, or orthopedists may recommend activities and exercise, along with specialized equipment including a gait trainer (walker) or stander to help your child bear weight.
A diet rich in calcium and vitamin D is also critical to maintaining bone health. Calcium is the building block of bones. Vitamin D helps the body absorb calcium. A typical source of calcium is milk, and a major source of vitamin D is sunshine. It is not uncommon for children with SNI to have dietary issues with milk and, due to physical limitations, they may spend less time exposed to natural sunlight. A dietician can recommend dietary changes or determine if vitamin D or calcium supplementation is needed to support bone health.
Tests
A DEXA scan is a type of medical imaging test using low X-ray levels in order to measure bone mineral density. However, it can be a working assumption that a child who is unable to bear their weight has osteoporosis. Given the risks with long-term use, the medications used to treat osteoporosis in the elderly, called bisphosphonates, are only used in children with non-walking osteoporosis if a fragility fracture occurs. A DEXA scan is obtained before starting treatment to compare results after treatment. An endocrinologist will discuss whether it makes sense to use a bisphosphonate or to monitor and use if more fractures occur.
ESP Even with assurance that fragility fractures may have no known cause, you might feel worried that you did something wrong or feel responsible for something you could not help. You may also begin to feel fear of hurting your child and causing more fractures. It is important to recognize that fragility fractures can happen even with the gentlest loving care and can be treated and healed.