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Overview of Bone Disorders in Children

by David D. Sherry, MD, Frank Pessler, MD, PhD

  • Bone disorders can be caused by injury or cancer, be inherited, occur as part of a child’s growth, or occur for no known reason.

  • Some bone disorders can cause pain and difficulties walking, whereas others cause no symptoms.

  • Doctors base the diagnosis on a thorough history, close observation and examination, and the selective use of x-rays.

  • Treatment depends on the disorder.

Children’s bones grow continually and reshape (remodel) themselves extensively. Growth proceeds from a vulnerable part of the bone called the growth plate. In remodeling, old bone tissue is gradually replaced by new bone tissue (see Bones). Many bone disorders come from the changes that occur in a growing child’s musculoskeletal system. These disorders may get better or worsen as the child grows. Other bone disorders may be inherited or occur in childhood for no known reason.

Causes

Bone disorders in children can result from such causes as injuries, cancer, and infections. Causes that affect mainly children typically involve the gradual misalignment of bones, which is caused by forces exerted on the growth plates as children are developing. A poor blood supply can also damage the growth plate, as can separation from the rest of the bone or even minor misalignment. Damage to the growth plate suppresses the growth of bones, distorts the joint, and can cause long-lasting joint damage (arthritis).

Certain rare hereditary disorders of connective tissue (see Overview of Hereditary Connective Tissue Disorders) can also affect the bones. They include Marfan syndrome, osteogenesis imperfecta, chondrodysplasias, and osteopetroses.

Symptoms and Diagnosis

Bone disorders sometimes cause painless deformities. Some deformities may affect a child’s ability to walk or use the limbs. The diagnosis of a bone disorder typically involves a thorough history, close observation and examination, and the selective use of x-rays and laboratory studies.

Treatment

Treatment of bone disorders varies depending on the condition. Children may outgrow some disorders. However, others may require bracing or surgical intervention.

If the growth plate becomes damaged, surgery may help. Accurately realigning separated or misaligned ends of the growth plate may surgically restore normal bone growth. By decreasing the irritation caused by misalignment, surgery may prevent the development of arthritis in the joint.

If a bone disorder causes a physical deformity, children may become anxious or depressed. Some treatments for bone disorders may also be psychologically difficult to accept. For example, adolescents may be reluctant to wear a back brace for treatment of scoliosis because doing so makes them appear different from their peers. Professional counseling may relieve anxiety or depression. Counseling may also help children go through with difficult treatments.

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