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To the Editor: Dr Khosla and colleagues¹ found an increasing incidence of distal forearm fractures in children during the past 30 years. The authors suggested that this might be a reflection of changing patterns of physical activity or possibly of decreased bone acquisition due to poor calcium intake. It is also possible, however, that parents have had increasing access to diagnosis and medical care during this time. Similarly, physicians may be more likely to order radiographs than they were 30 years ago. An analysis of rates of negative radiographic examinations over the past 30 years may help to resolve this possible source of bias.

Marc F. Swiontkowski, MD
Department of Orthopaedic Surgery
University of Minnesota School of Medicine
Minneapolis

1. Kholsa S, Milton LJ III, Dekutoski MB, Achenbach SJ, Oberg AL, Riggs BL. Incidence of childhood distal forearm fractures over 30 years: a population-based study. JAMA. 2003;290:1479-1485. FREE FULL TEXT

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290:3193.

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