Bone fragility of a school child during COVID-19.

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.

Fig. 1

Imaging findings of bilateral femoral fragility fractures of a school child

Fig. 1A: MRI T2-weighted image shows bilateral distal femoral metaphyseal fracture lines (white arrows) in a 13-year-old school child.

Fig. 1B: Plain x-ray shows bilateral distal femoral metaphyseal fractures (white arrows) and reactive bone formation.

Thus, under the influence of COVID-19, school children who lack exercise or sunbathing need guidance to prevent bone fragility.

ACKNOWLEDGEMENT

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

CONFLICT OF INTEREST

Nothing to declare.