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There is no \u201cgold standard\u201d for the evaluation and treatment of children with fractures and low bone mineral density (BMD); therefore, the diagnosis of osteoporosis in a pediatric patient should be made using a combination of clinical and radiographic features. Interpretation of bone densitometry in growing patients presents a unique set of challenges because areal BMD measured by dual-energy x-ray absorptiometry depends on multiple dynamic variables. Interpretation of pediatric dual-energy x-ray absorptiometry should be based on Z-scores (sd scores compared to age, sex, and ethnicity-matched controls), using normative databases specific to the brand of densitometer and the patient population. Given the skeleton's ability to recover from low BMD through modeling and remodeling, optimizing management of underlying conditions leading to bone fragility is the initial step. Conservative measures including calcium and vitamin D supplementation and weight-bearing physical activity are important interventions that should not be overlooked. The use of bisphosphonates in children and adolescents is controversial due to lack of long-term efficacy and safety data and should be limited to clinical trials and compassionate therapy in children with significantly compromised quality of life. Close monitoring is required, and further study is necessary to assess their long-term safety and efficacy in children.<\/jats:p>","DOI":"10.1210\/jc.2010-2546","type":"journal-article","created":{"date-parts":[[2011,7,6]],"date-time":"2011-07-06T17:50:05Z","timestamp":1309974605000},"page":"1943-1952","source":"Crossref","is-referenced-by-count":54,"title":["Approach to the Child with Fractures"],"prefix":"10.1210","volume":"96","author":[{"given":"Alison M.","family":"Boyce","sequence":"first","affiliation":[{"name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development (A.M.B.), Bethesda, Maryland 20892"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel I.","family":"Gafni","sequence":"additional","affiliation":[{"name":"National Institute of Dental and Craniofacial Research, National Institutes of Health (R.I.G.), Bethesda, Maryland 20892"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","reference":[{"key":"2020071618055813800_B1","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1097\/01202412-199704000-00002","article-title":"Epidemiology of children's fractures.","volume":"6","author":"Landin","year":"1997","journal-title":"J Pediatr Orthop B"},{"key":"2020071618055813800_B2","doi-asserted-by":"crossref","first-page":"148","DOI":"10.3109\/17453671003628780","article-title":"Epidemiology of fractures in children and adolescents.","volume":"81","author":"Hedstr\u00f6m","year":"2010","journal-title":"Acta Orthop"},{"key":"2020071618055813800_B3","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1007\/s001980200137","article-title":"How many children remain fracture-free during growth? a longitudinal study of children and adolescents participating in the Dunedin Multidisciplinary Health and Development Study.","volume":"13","author":"Jones","year":"2002","journal-title":"Osteoporos Int"},{"key":"2020071618055813800_B4","doi-asserted-by":"crossref","first-page":"1479","DOI":"10.1001\/jama.290.11.1479","article-title":"Incidence of childhood distal forearm fractures over 30 years: a population-based study.","volume":"290","author":"Khosla","year":"2003","journal-title":"JAMA"},{"key":"2020071618055813800_B5","doi-asserted-by":"crossref","first-page":"2476","DOI":"10.1002\/jbmr.155","article-title":"Decreasing incidence and changing pattern of childhood fractures: a population-based study.","volume":"25","author":"M\u00e4yr\u00e4np\u00e4\u00e4","year":"2010","journal-title":"J Bone Miner Res"},{"key":"2020071618055813800_B6","first-page":"1","article-title":"Fracture patterns in children. 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