When a child shows evidence of repeat fractures, you know to assess for child abuse. But ruling out osteoporosis may not occur to you when a patient is so young.

Maybe it should. According to a small study reported at the American Academy of Pediatrics national conference last fall, osteoporosis may be a more common contributor to childhood fractures than most clinicians realize.

Researchers evaluated 447 children who had multiple fractures from minimal trauma. No underlying disorders or steroid use could explain the fractures. Sixteen of these children underwent a dual-energy X-ray absorptiometry (DEXA) scan of the spine and hip. Testing revealed osteoporosis in 67% of children ages 6 to 13, say the researchers, who recommend DEXA scanning for children in this age range who repeatedly fracture bones.

Other clinicians at the conference questioned the validity of the DEXA results, noting that bone density norms haven't been established in children and that the scans may in fact show normal growth progression. The National Institutes of Health is currently studying the issue and may soon release bone density parameters for children.

The American Academy of Pediatrics National Conference and Exhibition was held in New Orleans, La., in November.