Inpatient Clinical Pathway for Screening
Infants and Children at Risk for Fractures
Admitted Infants and Children
- Assess
- Presence of primary bone disorder
- Significant fracture history
- Rickets reported on X-ray
- Followed by Bone Health
- Risk factors
No Risk Factors
- Reassess risk factors q4wks
Infant < 12 mos
with ≥ 1 risk factors
with ≥ 1 risk factors
Child ≥ 12 mos
with ≥ 1 risk factors
with ≥ 1 risk factors
- TPN panel or
- CMP and Phosphorus
- Review available X-rays
Normal
Abnormal
Repeat Primary Screen
q2-4wks
q2-4wks
Abnormal
- Infant Secondary Screening
- Parathyroid hormone
- 25 OH vitamin D level
- BMP, Phos
- Urine Ca/Cr Ratio,
TRP Calculation - Additional X-rays as
clinically indicated - Neonatal and Pediatric
Bone Health Orderset
Normal
- Consider stopping primary screen
at 37 wks corrected gestational age - or
- After 2-3 normal primary screens despite chronic risk factor(s)
Abnormal
Fragile Bones Prevention
and Management
and Management
- Vitamin D Treatment
as indicated - Bone Health consult
- Bone Health Promotion
Care Guidelines - Post Fragile Bones Sign
- Neonatal and Pediatric
Bone Health Orderset
Child Primary Screening
- Fragile Bones Sign
- CMP, Phos, 25(OH) vitamin D
- Urine Ca/Cr
- PTH
- Review existing radiology reports
- Demineralization
- Osteopenia
- Rickets
- Neonatal and Pediatric Bone Health Orderset
Low or Normal 25(OH) Vit D
Other labs Normal
Other labs Normal
Low or Normal 25(OH) Vit D
Other labs Abnormal
Other labs Abnormal
- Vitamin D Treatment as indicated
- Repeat primary screen q4wks
Fragile Bones Prevention
and Management
and Management
- Vitamin D Treatment as indicated
- Bone Health consult
- Bone Health Promotion
Care Guidelines - Consider additional imaging
- DXA, lateral spine X-ray
- Consider stopping primary screening after 2-3 normal screens despite chronic risk factors
Continued screening per Bone Health
Known High Fracture Risk
Fragile Bones Prevention and Management
- Bone Health consult
- Bone Health Promotion Care Guidelines
- Post Fragile Bones Sign
- Neonatal and Pediatric Bone Health Orderset