Osteoporosis International

, Volume 22, Issue 2, pp 607–616 | Cite as

Fracture risk in children with a forearm injury is associated with volumetric bone density and cortical area (by peripheral QCT) and areal bone density (by DXA)

  • H. J. Kalkwarf
  • T. Laor
  • J. A. Bean
Original Article



Children who sustain a forearm fracture when injured have lower bone density throughout their skeleton, and have a smaller cortical area and a lower strength index in their radius. Odds ratios per SD decrease in bone characteristics measured by peripheral quantitative computed tomography (pQCT) and dual-energy X-ray absorptiometry (DXA) were similar (1.28 to 1.41).


Forearm fractures are common in children. Bone strength is affected by bone mineral density (BMD) and bone geometry, including cross-sectional dimensions and distribution of mineral. Our objective was to identify bone characteristics that differed between children who sustained a forearm fracture compared to those who did not fracture when injured.


Children (5–16 years) with a forearm fracture (cases, n = 224) and injured controls without fracture (n = 200) were enrolled 28 ± 8 days following injury. Peripheral QCT scans of the radius (4% and 20% sites) were obtained to measure volumetric BMD (vBMD) of total, trabecular and cortical bone compartments, and bone geometry (area, cortical thickness, and strength strain index [SSI]). DXA scans (forearm, spine, and hip) were obtained to measure areal BMD (aBMD) and bone area. Receiver operating characteristic (ROC) analyses were used to assess screening performance of bone measurements.


At the 4% pQCT site, total vBMD, but not trabecular vBMD or bone area, was lower (−3.4%; p = 0.02) in cases than controls. At the 20% site, cases had lower cortical vBMD (−0.9%), cortical area (−2.8%), and SSI (−4.6%) (p < 0.05). aBMD, but not bone area, at the 1/3 radius, spine, and hip were 2.7–3.3% lower for cases (p < 0.01). Odds ratios per 1 SD decrease in bone measures (1.28–1.41) and areas under the ROC curves (0.56–0.59) were similar for all bone measures.


Low vBMD, aBMD, cortical area, and SSI of the distal radius were associated with an increased fracture risk. Interventions to increase these characteristics are needed to help reduce forearm fracture occurrence.


Bone densitometry Epidemiology Fracture Orthopedics Pediatrics QCT 



We would like to thank the subjects and their families who generously donated their time to participate in this study. We also would like to thank the staff responsible for data collection Donna Bianchi, Ashwini-Roy Chaudhury, Gemma Uetrecht and Caroline Wood.

Conflicts of interest



This project was supported by NIH grants AR47242 and RR08084, from the General Clinical Research Centers Program


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2010

Authors and Affiliations

  1. 1.Division of General and Community PediatricsCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Department of RadiologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  3. 3.Epidemiology and BiostatisticsCincinnati Children’s Hospital Medical CenterCincinnatiUSA

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