key: cord-0837311-ubphktji
authors: Nishida, Yoshihiro; Ikuta, Kunihiro
title: Bone fragility of a school child during COVID-19
date: 2021-02-03
journal: Nagoya J Med Sci
DOI: 10.18999/nagjms.83.1.217
sha: d610e7a265f13b4a8113d9531ba2215c83e42fe8
doc_id: 837311
cord_uid: ubphktji

nan

Osteoporosis and fragility fractures in the elderly pose a serious challenge to proper diagnosis and management during the COVID-19 outbreak. 1 Therefore, it is important to advocate the care and prevention of acute and long-term fragility fractures by governments and national health service providers. 2 Regarding children, acute fracture incidence has decreased during the COVID-19 pandemic, partially because of cessation of organized sports and decreased playground use. 3 However, under the influence of COVID-19, there is a need to warn that children's bones might be weakened due to less sporting opportunities and less sun exposure.

A 13-year-old school child was referred to our hospital from a nearby general hospital with a chief complaint of bilateral distal thigh pain of 4 weeks' duration. He had no history of systemic steroid administration for diseases. He had no history of trauma before the bilateral distal thigh pain appeared either. On the other hand, due to COVID-19, his junior high school had been closed for 3 months, with the bilateral thigh pain appearing immediately after re-starting school. At that time, he walked for about 1km to school for the first time in the three months. A magnetic resonance imaging (MRI) T2-weighted image at the time of referral to our hospital showed fractures of the distal metaphyses of the bilateral femurs. Fractures were recognized also on plain X-ray ( Figure 1 ). The bone mineral density was decreased to 86% of the average value for the same age group, and serum 25(OH)D level was relatively low at 25 ng/ml. He had stayed indoors and been barely exposed to sunlight during the three-month closure of his school. He did not play sports when his school re-started. He was diagnosed with bilateral femoral fragility fractures possibly due to immobility and indoor life under the influence of COVID-19. He wore orthotics, performing weighted walking training, and sunbathing. In 3 months, the fractures healed, and he went to school on a full load walk.

Thus, under the influence of COVID-19, school children who lack exercise or sunbathing need guidance to prevent bone fragility. 13-year-old school child. Fig. 1B : Plain x-ray shows bilateral distal femoral metaphyseal fractures (white arrows) and reactive bone formation.

Challenges and strategies in management of osteoporosis and fragility fracture care during COVID-19 pandemic

Managing fragility fractures during the COVID-19 pandemic

Where Have All the Fractures Gone? The Epidemiology of Pediatric Fractures During the COVID-19 Pandemic

We thank for the patient and his parent for approval of the submission.

Nothing to declare.