Background:
Major paediatric burns trigger a prolonged hypermetabolic response, raising concerns for long-term skeletal impacts, including reduced bone mineral density (BMD) and increased fracture risk. While previous studies have suggested significant post-burn bone loss, evidence remains inconsistent, and clinical guidelines for bone health monitoring are lacking.
Methods:
In this context we performed a retrospective cohort study assessing follow-up DEXA scan utilisation in paediatric major burn, defined as TBSA >20%, from 2005-2025. We extracted data pertaining to demographics, injury type and mechanism, use of metabolic modulators and follow-up.
Results:
We identified 49 patients of mean age 4.8 years (range 2 months to 16 years) with mean affected TBSA 40%, most frequently by flame burn (51%) or scald (46%). Three patients received metabolic modulators (oxandrolone and/or propranolol). 10 patients were recommended for DEXA scans by the multidisciplinary team, 8 underwent imaging and two did not attend or declined scans. Mean time from discharge to first scan was 1065 days post-admission (range 104-3996). Patients who received a metabolic modulator were recommended for baseline DXA scans at 6 months. 6 of 8 patients recorded normal imaging results. Two patients recorded ‘at risk for low’ or ‘low’ BMD with annual surveillance scans. One patient, who had oxandrolone, required three follow-up scans until normalisation of his BMD. At study completion all patients returned to baseline BMD.
Conclusion:
Skeletal health is an under-recognised aspect of burn recovery and its assessment and management poses nuanced challenges. Surprisingly, our findings suggest that clinically significant bone injury may be less common than previously reported, with the majority of patients demonstrating normal BMD on follow-up. Our presentation and literature review helps suggest a guide for clinicians to monitor bone health of our long-term paediatric major burns patients.