Merck Manual

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Overview of Bone Disorders in Children


Frank Pessler

, MD, PhD, Hannover, Germany

Last full review/revision Oct 2020| Content last modified Oct 2020
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Topic Resources
  • Bone disorders can be caused by injury, infection, 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 difficulty 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 or magnetic resonance imaging (MRI).

  • 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. 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.

Growth plates

People think of bones as solid objects. But bones need to grow along with the rest of the child's body. Children's bones grow from soft areas of cartilage near the ends of bones. These areas are called growth plates. When children have finished growing, growth plates become solid bone. After growth plates become solid, bones do not grow in length. That is why people do not become taller after a certain point in late adolescence. Although bones repair themselves, such as after an injury, that repair does not involve the growth plates.

During childhood, injuries to the growth plate can cause the bone to grow abnormally.

Osteochondrosis refers to a group of disorders of the growth plate that occur when the child is growing rapidly. Doctors are not sure what causes osteochondrosis, but the disorders do seem to run in families. Osteochondroses include Köhler bone disease, Legg-Calvé-Perthes disease, Osgood-Schlatter disease, and Scheuermann disease.

Locating the Growth Plates

Growth plates (indicated by the pink lines) are areas of cartilage near the ends of long bones, such as the arm and leg bones. They enable bones to lengthen until children reach their full height.

Locating the Growth Plates


Bone disorders in children can result from causes that affect people of all ages, including injury, infection (osteomyelitis), or cancer. Causes of bone disorders 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 connective tissue disorders can also affect the bones. They include Marfan syndrome, osteogenesis imperfecta, and osteochondrodysplasias. Osteopetroses are other rare hereditary disorders that increase the density of bones, cause bones to grow abnormally, or both.


Bone disorders sometimes cause painless deformities. Some deformities may affect a child’s ability to walk or use the limbs.


  • A doctor's evaluation

  • X-rays, magnetic resonance imaging (MRI), and laboratory tests

The diagnosis of a bone disorder typically involves a thorough history, close observation and examination, and the selective use of x-rays, MRI, and laboratory studies.


  • Depends on the disorder

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.

NOTE: This is the Consumer Version. DOCTORS: Click here for the Professional Version
Click here for the Professional Version
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