Fragile Bones

Important information:

Fragile bones are bones that have a greater risk for breaking (fracturing) than normal bones.

If your child’s healthcare provider has concerns about their bone health, they may order tests to look at:

• Density: A measure of bone strength based upon the amount of mineral in the bone done by a dual energy X-ray absorptiometry (DXA) scan.

• Appearance: The size and shape of the bones contributes to bone strength. X-rays can be done to look for a fracture or other visible signs of weak bones.

Many things increase the risk for having fragile bones:

• Bone diseases such as osteogenesis imperfecta, rickets, and bone disease of prematurity

• Neuromuscular disease (cerebral palsy, spina bifida, muscular dystrophy)

• Chronic kidney disease (especially if it requires dialysis)

• Chronic GI diseases, such as Crohn’s disease and ulcerative colitis

• Eating disorders

• Sickle cell disease, thalassemia

• Juvenile idiopathic arthritis, connective tissue disease

• Organ transplant

• Not being able to move independently, being immobile for a long time, or change in how you get around (ambulatory status)

• Previous fractures, especially from low-trauma situations. Examples include falling from standing height or less, or a fracture from a fall at walking speed or slower

Some medicines also place a child at risk for fragile bones:

• Long-term steroid use

• Anti-seizure medications

• Long-term heparin use

• Total parenteral nutrition (TPN)

• Diuretics

Instructions to prevent injury:

• Maintain your child’s natural body position.

• Handle your child gently with slow, careful movements.

• Do not pull or twist limbs.

• Do not bend or force limbs into an awkward or unnatural position.

• Hold close to joints (like elbows, hips, knees) when moving arms and legs.

• Support their head and limbs when you lift them.

• Lift from under the buttocks when changing diapers.

• When changing, gently bring sleeves or pants over limbs.

• Do not press on arms and legs, that can lead to a fracture.

• Always make sure the side rails of the bed/crib are up and secure.

• Talk with your team to determine how frequently your child needs their blood pressure taken.

• Ask for help when needed.

Reviewed July 2025 by David Weber MD MSCE, Andrew Calabria MD