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Moon RJ, Citeroni NL, Aihie RR, Harvey NC. Early Life Programming of Skeletal Health. Curr Osteoporos Rep 2023; 21:433-446. [PMID: 37335525 PMCID: PMC10393901 DOI: 10.1007/s11914-023-00800-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE OF REVIEW Increasing bone mineral accrual during childhood might delay the onset of osteoporosis. We discuss the scientific evidence for early life approaches to optimising skeletal health. RECENT FINDINGS There is an ever-growing body of evidence from observational studies suggesting associations between early life exposures, particularly during foetal development, and bone mineral density (BMD). The findings of such studies are often heterogeneous, and for some exposures, for example, maternal smoking and alcohol intake in pregnancy or age at conception, intervention studies are not feasible. The most frequently studied exposures in intervention studies are calcium or vitamin D supplementation in pregnancy, which overall suggest positive effects on offspring childhood BMD. Maternal calcium and/or vitamin D supplementation during pregnancy appear to have positive effects on offspring BMD during early childhood, but further long-term follow-up is required to demonstrate persistence of the effect into later life.
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Affiliation(s)
- Rebecca J. Moon
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton, SO16 6YD UK
- Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Natasha L. Citeroni
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton, SO16 6YD UK
| | | | - Nicholas C. Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton, SO16 6YD UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Matkovic V, Goel P, Mobley SL, Badenhop-Stevens NE, Ha EJ, Li B, Skugor M, Clairmont A. Decreased bone mass in adolescents with bone fragility fracture but not in young children: a case-control study. Front Endocrinol (Lausanne) 2023; 14:1124896. [PMID: 37223040 PMCID: PMC10200873 DOI: 10.3389/fendo.2023.1124896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/07/2023] [Indexed: 05/25/2023] Open
Abstract
Background The incidence of distal forearm fracture due to minimal/moderate trauma shows a bimodal distribution for age at event, with one peak occurring during early adolescence, in both boys and girls and the other one in postmenopausal females. The aim of this study was, therefore, to document whether the relationship between bone mineral density and fracture is different in young children compared with adolescents. Methods A matched-pair, case-control study has been conducted to evaluate bone mineral density in 469 young children and 387 adolescents of both sexes, with/without fracture due to minimal/moderate trauma with assurance that the compared groups were equally susceptible to the outcome event. All fractures were radiographically confirmed. The study utilized bone mineral areal density of the total body, spine, hips, and forearm; volumetric bone mineral density of the forearm; and metacarpal radiogrammetry measurements. The study controlled for skeletal development, bone geometry, body composition, hand grip strength, calcium intake, and vitamin D status. Results Adolescents with distal forearm fracture have reduced bone mineral density at multiple skeletal regions of interest. This was documented by the bone mineral areal density measurements at multiple skeletal sites (p < 0.001), volumetric bone mineral density measurements of the forearm (p < 0.0001), and metacarpal radiogrammetry (p < 0.001). Adolescent females with fracture had reduced cross-sectional areas of the radius and metacarpals. The bone status of young female and male children with fracture was no different to its controls. Increased body fatness was more prevalent among fracture cases than in controls. Around 72% of young female and male children with fracture had serum 25-hydroxyvitamin D levels below the threshold of 31 ng/ml, compared with only 42% of female controls and to 51% of male controls. Conclusions Adolescents with bone fragility fracture had reduced bone mineral density at multiple skeletal regions of interest, whereas this was not the case with younger children. The results of the study may have implications for the prevention of bone fragility in this segment of the pediatric population.
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Affiliation(s)
- Velimir Matkovic
- Bone and Mineral Metabolism Laboratory, Departments of Physical Medicine and Rehabilitation (PMR), Medicine, and Nutrition, The Ohio State University, Columbus, OH, United States
| | - Prem Goel
- Bone and Mineral Metabolism Laboratory, Departments of Physical Medicine and Rehabilitation (PMR), Medicine, and Nutrition, The Ohio State University, Columbus, OH, United States
| | - Stacey L. Mobley
- Department of Statistics, The Ohio State University, Columbus, OH, United States
| | - Nancy E. Badenhop-Stevens
- Bone and Mineral Metabolism Laboratory, Departments of Physical Medicine and Rehabilitation (PMR), Medicine, and Nutrition, The Ohio State University, Columbus, OH, United States
| | - Eun-Jeong Ha
- Food Sciences and Human Nutrition Department, University of Florida, Gainesville, FL, United States
| | - Bin Li
- Department of Nutrition, Kent State University, Kent, OH, United States
| | - Mario Skugor
- Department of Experimental Statistics, Louisiana State University, Baton Rouge, LA, United States
| | - Albert Clairmont
- Department of Endocrinology, Cleveland Clinic, Cleveland, OH, United States
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Xiao X, Ding Y, Zheng Y, Gao Y, Li H, Liu R, Xu R, Hong P. Epidemiological Investigation of Pediatric Fractures-A Retrospective Cohort Study of 1129 Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59040788. [PMID: 37109745 PMCID: PMC10144156 DOI: 10.3390/medicina59040788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/15/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Abstract
Background and Objectives: Fractures are common in pediatric trauma, and they are caused by a broad spectrum of factors. Only a few studies have discussed the mechanisms of injury and their relationships to different types of fractures. The most frequent type of fractures in different age groups remains unclear. Therefore, we aim to summarize the epidemiological characteristics of pediatric fractures in a medical center in Zhuhai, China from 2006 to 2021 and analyze the causes of fractures with the highest frequency in different age groups. Materials and Methods: We extracted the information from the Zhuhai Center for Maternal and Child Health Care of those under 14 years old who had fractures from 2006 to 2021. Results: We reviewed the information of 1145 children. The number of patients increased during the 15 years (p < 0.0001). The number of patients was significantly different between genders after Y2 (p = 0.014). In addition, more than two-thirds of patients (71.3%) had upper limb fractures, and all types of falls were the most common cause of fractures (83.6%). The incidence demonstrated an insignificant difference in age groups except for the fractures of humerus and radius. Moreover, we discovered that the prevalence of fall-related injuries decreased with age, while that of sports-related injuries increased with age. Conclusions: Our study demonstrates that the prevalence of fall-related injuries decreases with age, and that of sports-related injuries increases with age. Most patients have upper limb fractures, and all types of falls are the most common cause of fractures. Fracture types with the highest frequency differ in each age group. These findings might supplement current epidemiological knowledge of childhood fracture and provide references for decision-making in children's health policies.
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Affiliation(s)
- Xiaoliang Xiao
- Department of Orthopaedic Surgery, Zhuhai Center for Maternal and Child Health Care, Zhuhai 519000, China
| | - Yuhong Ding
- Second Clinical School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Yiqiu Zheng
- Basic Medical School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Yun Gao
- Department of Orthopaedic Surgery, Zhuhai Center for Maternal and Child Health Care, Zhuhai 519000, China
| | - Huaqing Li
- Department of Orthopaedic Surgery, Zhuhai Center for Maternal and Child Health Care, Zhuhai 519000, China
| | - Ruikang Liu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Ruijing Xu
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Pan Hong
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430074, China
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Rukuni R, Simms V, Rehman AM, Mukwasi-Kahari C, Mujuru H, Ferrand RA, Gregson CL. Fracture prevalence and its association with bone density among children living with HIV in Zimbabwe. AIDS 2023; 37:759-767. [PMID: 36728418 PMCID: PMC9994799 DOI: 10.1097/qad.0000000000003477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/26/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES HIV infection impairs bone density in children living with HIV (CLWH). We aimed to determine the prevalence of self-reported fracture (past or current), associated risk factors and disability, by HIV status in Zimbabwean children. DESIGN Cross-sectional study. METHODS We recruited CLWH aged 8-16 years taking antiretroviral therapy (ART) for ≥2 years from HIV clinics, and HIV-uninfected children from schools in Harare. Interviewer-administered questionnaires collected data on fracture site and management, sociodemographics, dietary calcium and vitamin D, physical activity and HIV history. Dual-energy X-ray absorptiometry (DXA) measured size-adjusted bone density. RESULTS We recruited 303 CLWH [mean (SD) age 12.5 (2.5) years; 50% female] and 306 children without HIV [12.5 (2.5) years; 51% female]. Median age at HIV diagnosis in CLWH was 3.0 years [interquartile range (IQR) 1.2, 5.9], and median ART duration 8.1 years [IQR 6.2, 9.5]. 53.8% CLWH had self-reported disability and/or functional impairment, vs. 29.4% children without HIV. Fracture prevalence was 5.9% with no difference by HIV status [21/306 (6.9%) vs. 14/303 (4.6%), P = 0.24]. Male sex was associated with fractures. Low size-adjusted bone density ( Z -score < -2) was associated with prevalent fractures in CLWH {risk ratio [RR] 1.14 (95% confidence interval (CI) -0.02, 2.29]}, but not in children without HIV [RR -0.04 (-2.00, 1.91)], P -interaction = 0.27. All sought medical attention for their fracture(s), but CLWH were less often admitted to hospital [2/14 (14.3%) vs. 7/21 (33.3%)]. CONCLUSION Prevalent fractures may be associated with low lumbar spine bone density in CLWH. Fracture surveillance and strategies to reduce future fracture risk are warranted as CLWH enter adulthood.
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Affiliation(s)
- Ruramayi Rukuni
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Victoria Simms
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, Faculty of Epidemiology and Population Health
| | - Andrea M. Rehman
- MRC International Statistics and Epidemiology Group, Faculty of Epidemiology and Population Health
| | - Cynthia Mukwasi-Kahari
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Hilda Mujuru
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Rashida A. Ferrand
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Celia L. Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Kim MJ, Jillian H, Rachael T, Debra W, Sean H, Sandhya R, Richie P. Is repeated childhood fracture related to areal bone density or body composition in middle age? Osteoporos Int 2022; 33:2369-2379. [PMID: 35918403 PMCID: PMC9568436 DOI: 10.1007/s00198-022-06500-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022]
Abstract
Childhood fracture is common, but whether it predicts adult fracture is not clear. Repeat childhood fracture was associated with adult (≤ 45 years) fracture, and in women, lower areal bone density was associated with repeat childhood fracture. Identifying fracture-prone children can modify adult fracture risk management. INTRODUCTION A quarter of boys and 15% of girls will suffer multiple fractures, but it is not clear whether multiple fractures during growth predict fracture risk and areal bone density in adulthood. This study evaluated whether children who repeatedly fracture were at increased risk of low areal bone density, abnormal body composition, and fractures by age 45. METHODS A subsample of a large birth cohort study with childhood fracture cases had areal bone density assessed at age 45 years. Participants were questioned regularly across their lifetime about fractures during childhood (ages 0-18 years of age) and adulthood (any fracture between 18 and 45 years). The number of fractures was collapsed into three categories: no fractures; 1 fracture; and > 1 fracture, separately for child and adult groups. RESULTS At age 45 years, areal bone mineral density (g/cm2) and body composition were measured with dual X-ray absorptiometry in n = 555 participants. Compared to no fractures, twice as many girls (14% vs 7%, P = 0.156) and boys (31.4% vs 14.1%, P = 0.004) who repeatedly fractured in childhood sustained multiple fractures as adults. Both girls and boys who were fracture-free tended to remain fracture-free as adults (79.8% compared with 62.8%, P = 0.045, and 64.8% compared with 51.4%, P = 0.025, in males and females, respectively). Participants were more than twice as likely to fracture repeatedly as adults if they had sustained multiple fractures as a child (OR 2.5 95% CI: 1.4, 4.6). Women who repeatedly fractured during childhood had lower areal bone density, whereas repeated fracturing during childhood was not associated with areal bone density or body composition in men, even after adjustment for other factors known to influence fracture history. CONCLUSION Childhood fracture history is associated with persistent skeletal fragility in adulthood (≤ 45 years), even after adjustment for behavioral and demographic factors known to influence fracture history.
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Affiliation(s)
- Meredith-Jones Kim
- Department of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand.
| | - Haszard Jillian
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | - Taylor Rachael
- Department of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Waters Debra
- Department of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Hogan Sean
- Department of Psychology, The Dunedin Multidisciplinary Health and Development Research Unit, Dunedin, New Zealand
| | - Ramrakha Sandhya
- Department of Psychology, The Dunedin Multidisciplinary Health and Development Research Unit, Dunedin, New Zealand
| | - Poulton Richie
- Department of Psychology, The Dunedin Multidisciplinary Health and Development Research Unit, Dunedin, New Zealand
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Risk factors for upper limb fractures due to unintentional injuries among adolescents: a case control study from Sri Lanka. BMC Public Health 2022; 22:1825. [PMID: 36162991 PMCID: PMC9513863 DOI: 10.1186/s12889-022-14154-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Injuries are the number one cause for morbidity and mortality among adolescents. Adolescent fractures are a hidden public health problem in Sri Lanka. Upper limb fractures are common in adolescents due to various risk factors. Many injuries are predictable and can be prevented by identifying the risk factors. The aim of the study was to determine the risk factors for upper limb fractures among adolescents in Sri Lanka. Methods A case control study was undertaken with 450 cases and 450 controls. Cases were recruited consecutively from all major hospitals among the adolescent victims who had admitted with newly diagnosed upper limb fractures in the district of Colombo. Controls were apparently healthy adolescents from the same district and excluded who had previous upper limb fractures. The age and gender were not matched in selecting controls since these two factors were potential risk factors for adolescent fractures according to previous literature. Risk factors for upper limb fractures were assessed by odds ratio (OR) with 95% confidence interval (CI) and adjusted for possible confounding by performing logistic regression analysis. Results The mean age of the cases was 13.62 years with a Standard Deviation (SD) of 2.8 and controls was 12.75 years (SD = 2.7) respectively. Having a high standard of living index (OR = 3.52; 95%CI: 2.3–5.2, p < 0.001), being in a high social class category (social class I & II) (OR = 2.58, 95%CI: 1.7–3.92, p < 0.001), engage in physical or sports activity (OR = 9.36; 95%CI: 3.31–26.47, p < 0.001), watching television (OR = 1.95; 95%CI: 1.18 -3.22, p = 0.009), playing video or computer games (OR = 2.35; 95%CI: 1.7–3.24, p < 0.001), and attending extra classes (OR = 1.82; 95%CI: 1.2–2.7, p = 0.007) were risk factors for having a upper limb fracture. Risk factors for upper limb fractures following adjusted for confounders were siblings in the family (aOR = 11.62, 95% CI: 6.95–41.29, p = 0.03) and attend extra classes after school hours (aOR = 2.51, 95%CI: 0.68–0.93, p = 0.04). Two significant effect modifications between being a Buddhist and low standard of living index (p < 0.001) and having one sibling in the family and attend extra classes after school hours (p = 0.01) were observed. Conclusions Modifiable risk factors in relation to lifestyle factors and socioeconomic position were important determinants of upper limb fracture risk in adolescents. Many fractures can be prevented by strengthening awareness programmes in the community.
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Braun BJ, Grimm B, Hanflik AM, Richter PH, Sivananthan S, Yarboro SR, Marmor MT. Wearable technology in orthopedic trauma surgery - An AO trauma survey and review of current and future applications. Injury 2022; 53:1961-1965. [PMID: 35307166 DOI: 10.1016/j.injury.2022.03.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/11/2022] [Accepted: 03/12/2022] [Indexed: 02/02/2023]
Abstract
The use of wearable sensors to track activity is increasing. Therefore, a survey among AO Trauma members was conducted to provide an overview of their current utilization and determine future needs and directions. A cross sectional expert opinion survey was administered to members of AO Trauma. Respondents were surveyed concerning their experience, subspeciality, current use characteristics, as well as future needs concerning wearable technology. Three hundred and thirty-three survey sets were available for analysis (Response Rate 16.2%). 20.7% of respondents already use wearable technology as part of their clinical treatment. The most prevalent technology was accelerometry combined with smartphones (75.4%) to measure general patient activity. To facilitate the use of wearable technology in the future, the most pressing issues were cost, patient compliance and validity of results. Wearable activity monitors are currently being used in trauma surgery. Surgeons employing these technologies mostly measure simple activity or activity associated parameters. Cost was the greatest perceived barrier to implementation. Further research, especially concerning the interpretation of the outcome values obtained, is required to facilitate wearable activity monitoring as an objective patient outcome measurement tool.
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Affiliation(s)
- Benedikt J Braun
- University Hospital Tuebingen on Behalf of the Eberhard-Karls-University Tuebingen, BG Hospital, Schnarrenbergstr. 95, Tuebingen 72076, Germany.
| | - Bernd Grimm
- Human Motion, Orthopaedics, Sports Medicine and Digital Methods Group, Luxembourg, Institute of Health, Transversal activities, Luxembourg, Luxembourg
| | - Andrew M Hanflik
- Department of Orthopaedic Surgery, Southern California Permanente Medical Group, Downey Medical Center, Kaiser Permanente Downey, CA, United States
| | - Peter H Richter
- Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany
| | | | | | - Meir T Marmor
- Orthopaedic Trauma Institute (OTI), San Francisco General Hospital, University of California, San Francisco, San Francisco, CA, United States
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Levels of Physical Activity in Children with Extremity Fractures a Dutch Observational Cross-Sectional Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030325. [PMID: 35327697 PMCID: PMC8947536 DOI: 10.3390/children9030325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 11/17/2022]
Abstract
Background: Fractures are common in children and a frequent cause of emergency department (ED) visits. Fractures can cause long-term complications, such as growth problems. Research on fractures can reveal useful areas of focus for injury prevention. Objective: To assess the role of physical activity in the occurrence of fractures, this study investigates physical activity among children with extremity fractures based on the Global Recommendations on Physical Activity for Health. Methods: A multi-center, cross-sectional study was performed at two EDs in Nijmegen, the Netherlands. Patients between 4 and 18 years of age visiting these EDs with a fracture were asked to complete a validated questionnaire. Results: Of the 188 respondents, 51% were found to adhere to the recommendations. Among participants between 13 and 18 years of age, 43% were adequately physically active, compared to participants between 4 and 12 years of age among whom 56% were adequately physically active (p = 0.080). Additionally, more males were found to meet the recommendations (60% versus 40%). The most common traumas were sports-related (57%). Sports-related traumas were cited more often among youth between 13 and 18 years of age, compared to those between 4 and 12 (p < 0.001). Conclusions: A relatively high prevalence of adherence to the Global Recommendations on Physical Activity for Health was observed among children with fractures. Most respondents obtained their fractures during participation in sports. This study emphasizes the need for more injury prevention, especially among youth between 13 and 18 years of age and children participating in sports.
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Agar A, Sahin A, Gunes O, Gulabi D, Erturk C. Seasonal variation in paediatric orthopaedic trauma Patients - A single centre experience from Turkey. J Orthop Surg (Hong Kong) 2022; 30:23094990211068146. [PMID: 35045744 DOI: 10.1177/23094990211068146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE It is known that the incidence of paediatric orthopaedic trauma peaks in the summer months as a result of increased and uncontrolled physical activity. The aim of this study was to review the experience of a single centre with paediatric orthopaedic traumas and determine the relationship between the severity and the variations in the incidence of traumas in relation to the seasons and temperatures during the study period. MATERIALS AND METHODS A single institutional review of the historical data of all patients aged 0-16 years who presented for orthopaedic trauma between January 2018 and December 2020 in the emergency department of Level 1 tertiary orthopaedic trauma centre was conducted. 65,182 paediatric orthopaedic trauma cases had been retrieved from the hospital data base during the 3 -year study period. We classified the traumas according to the variants of the patients' and by holidays, seasons, school days and weekends, months and in which part of the body it occurred. RESULTS After excluding the summer vacation, 77% of paediatric orthopaedic trauma patients attended to the hospital on weekdays and 23% on weekends. While it was observed that hot weather had a statistically positive effect on trauma attendance, rainy weather had an negative effect (p < 0.05). Trauma attendances were found to be statistically higher in summer months, except for injuries that may occur with indoor activities such as metacarpal fracture, phalanx fracture and pulled elbow (p < 0.05). CONCLUSION Orthopaedic trauma at a Level 1 tertiary health care trauma center do vary significantly with the weather and are highest in the summer season. Therefore, it should focus more attention on preventive strategies for paediatric trauma in the summer season.
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Affiliation(s)
- Anil Agar
- Department Orthopaedic and Traumatology, Kanuni Sultan Suleyman Training and Research Hospital, 147006Saglik Bilimleri University, Istanbul, Turkey
| | - Adem Sahin
- Department Orthopaedic and Traumatology, Kanuni Sultan Suleyman Training and Research Hospital, 147006Saglik Bilimleri University, Istanbul, Turkey
| | - Orhan Gunes
- Department Orthopaedic and Traumatology, Kanuni Sultan Suleyman Training and Research Hospital, 147006Saglik Bilimleri University, Istanbul, Turkey
| | - Deniz Gulabi
- Department Orthopaedic and Traumatology, Kanuni Sultan Suleyman Training and Research Hospital, 147006Saglik Bilimleri University, Istanbul, Turkey
| | - Cemil Erturk
- Department Orthopaedic and Traumatology, Kanuni Sultan Suleyman Training and Research Hospital, 147006Saglik Bilimleri University, Istanbul, Turkey
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Bone mineral density and oxidative stress in adolescent girls with anorexia nervosa. Eur J Pediatr 2022; 181:311-321. [PMID: 34292351 DOI: 10.1007/s00431-021-04199-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/01/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
Oxidative stress appears to be involved in the pathogenesis of osteoporosis-a serious complication of anorexia nervosa (AN). We evaluated the oxidative status in adolescent girls with AN and its potential relationship with bone mineral density (BMD). Girls with AN (n = 43) and age-matched healthy controls (n = 20) underwent anthropometric and BMD examination. Markers of bone turnover, oxidative stress, and antioxidant status were measured. Participants with AN and controls did not differ in BMD at the lumbar spine (p = 0.17) and total body less head BMD (p = 0.08). BMD at the total hip was lower (p < 0.001) in the AN group compared with the controls. Levels of antioxidant status markers-ferric reduction antioxidant power, total antioxidant capacity, and reduced and oxidized glutathione ratio (all p < 0.001)-were significantly lower, whereas those of advanced oxidation protein products (AOPP), fructosamines, and advanced glycation end products (AGEs) (all p < 0.001) were higher in AN patients than in healthy controls. BMD and bone turnover markers were positively correlated with antioxidant status markers, while they were negatively correlated with AOPP, fructosamines, and AGEs levels. Conclusion: This is the first study to assess a potential association between oxidative status and BMD in adolescents with AN. We demonstrated that in young girls, the imbalance of oxidative status and reduced BMD are concurrently manifested at the time of the diagnosis of AN. Disturbance of oxidative status could play a pathogenetic role in AN-associated decreased BMD. What is Known: • Osteoporosis is a serious complication of AN, and in affected adolescents may result in a permanent deficit in bone mass. • Oxidative and carbonyl stress may be involved in the development of bone loss. What is New: • Adolescents girls with AN have impaired antioxidant defense and increased oxidative damage to biomolecules. • Disturbance of oxidative status could affect bone loss and could contribute to decreased BMD in adolescent females with AN.
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Örgel M, Zimmer G, Graulich T, Gräff P, Macke C, Krettek C, Winkelmann M, Neunaber C. The impact of lifestyle on forearm fractures in children: A retrospective cohort analysis. Bone 2021; 153:116149. [PMID: 34390887 DOI: 10.1016/j.bone.2021.116149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/31/2021] [Accepted: 08/07/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Forearm fractures are frequent in children. It is important to identify predisposing factors for increased fracture risk. This retrospective analysis aimed to investigate the correlation between forearm fractures in children and co-factors such as age, TV consumption, consumption of soft drinks, the kind of soft drinks consumed as well as physical activity in daily life and BMI. METHODS This retrospective cohort analysis compared 355 participants at the age of 4 to 12 between 2017 and 2018 with and without forearm fractures in children. It was based on a questionnaire to assess the above-mentioned cofactors regarding behavior and lifestyles choices and aimed to identify whether or not these lead to an increased risk of forearm fractures. For statistical analysis logistic regression was used. RESULTS Logistic regression showed a significant effect on forearm fractures in children for the variables age (Odds ratio 3.3 [95% confidence interval 1.5-7.3], P = .003), TV consumption (Odds ratio 5.4 [95% confidence interval 2.5-22.6], P < .001), consumption of soft drinks (Odds ratio 2.6 [95% confidence interval 1.2-5.6], P = .013), and the kind of soft drinks consumed (Odds ratio 3.1 [95% confidence interval 1.5-6.3], P = .003), [Nagelkerkes-R2 = 0.458; Chi2 = 85.037; df = 6]) with a strong effect according to Cohen (f2 = 0.84). CONCLUSION The study showed a significant correlation between TV and soft drink consumption and increased risk for forearm fractures in children. TV consumption and consumption of soft drinks should be reduced in children to prevent forearm fractures.
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Affiliation(s)
- Marcus Örgel
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany.
| | - Giulia Zimmer
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Tilman Graulich
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Pascal Gräff
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Christian Macke
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Christian Krettek
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Marcel Winkelmann
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Claudia Neunaber
- Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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12
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Südow H, Navarro CM. The incidence of distal radius fractures in a Swedish pediatric population - an observational cohort study of 90 970 individual fractures. BMC Musculoskelet Disord 2021; 22:564. [PMID: 34147080 PMCID: PMC8214772 DOI: 10.1186/s12891-021-04410-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/24/2021] [Indexed: 12/25/2022] Open
Abstract
Background 40–50 % of all boys and 30–40 % of girls suffer from at least one fracture during childhood. A quarter of these fractures affects the wrist, making it the worst affected part of the body. Children often sustain the injury during play or sport activities. There has been a lifestyle change among European children during the last decades, and there is reason to believe that fracture incidence is changing. Methods For the purpose of this observational cohort study registry data was retrieved from the Swedish National Patient Register for all pediatric patients registered with a distal radius fracture during the period 2005–2013. Incidence rates were calculated for each year using data from Statistic Sweden on population size by age and gender. Results 90 970 distal radius fractures were identified. The mean age at the time of fracture was 10 years. In ages 10–17 the proportion of male patients was significantly larger. Seasonal variations were detected with peak incidences in May and September. A decreasing total fracture incidence was observed during the study period. Conclusions The incidence of distal radius fractures in a population 0–17 years in Sweden was higher among male than in female patients. The incidence was lower in 2008–2013 as compared to 2005. Further studies are necessary to reveal if the incidence will continue to decrease.
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Affiliation(s)
- Hanna Südow
- Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet, SE-118 83, Stockholm, Sweden. .,Department of Orthopeadics, Södersjukhuset Hospital, Sjukhusbacken 10, SE-118 46, Stockholm, Sweden.
| | - Cecilia Mellstrand Navarro
- Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet, SE-118 83, Stockholm, Sweden.,Department of Hand Surgery, Södersjukhuset Hospital, Stockholm, Sweden
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13
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Bergman E, Lempesis V, Jehpsson L, Rosengren BE, Karlsson MK. Childhood Distal Forearm Fracture Incidence in Malmö, Sweden 1950 to 2016. J Wrist Surg 2021; 10:129-135. [PMID: 33815948 PMCID: PMC8012093 DOI: 10.1055/s-0040-1720965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/05/2020] [Indexed: 10/22/2022]
Abstract
Background Distal forearm fracture is the most common pediatric fracture. As studies have indicated time trends in fracture incidence, we wanted to update the epidemiology and estimate time trends between 1950 and 2016 in Malmö, Sweden. Methods The city of Malmö, Sweden, had 318,107 inhabitants (58,585 of the population was aged <16 years) in 2014 and one hospital. We, therefore, used the hospital diagnosis registry and hospital medical records to identify and classify distal forearm fractures 2014 to 2016 in children aged 0 to 15 years. For long-term trend calculations, we also included published data from 1950 to 2006 (resulting in 17 evaluated years) and used joinpoint regression to estimate annual percent changes (APC). To describe differences in incidence between two periods, we calculated incident rate ratios (IRR) with 95% confidence intervals (95% CI) to describe uncertainty. Results Childhood distal forearm fracture incidence in 2014 to 2016 was 546/100,000 person-years (660 in boys and 427 in girls). The age-adjusted incidence in 2014 to 2016 and in 2005 to 2006 was similar (boys IRR 1.0, 95% CI: 0.9-1.2 and girls IRR 1.1, 95% CI: 0.9-1.3). Time-trend analyses from 1950 to 2016 revealed increasing age-adjusted incidence in both boys (APC +0.9%, 95% CI: 0.7-1.2) and girls (APC +0.6%, 95% CI: 0.3-0.9). Conclusion Distal forearm fracture incidence was similar in 2014 to 2016 and in 2005 to 2006. Age-adjusted incidence had increased in both sexes from 1950 to 2016. Level of Evidence This is a Level III b study.
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Affiliation(s)
- Erika Bergman
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Vasileios Lempesis
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Lars Jehpsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Björn E. Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus K. Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
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14
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Veldman SLC, Chin A Paw MJM, Altenburg TM. Physical activity and prospective associations with indicators of health and development in children aged <5 years: a systematic review. Int J Behav Nutr Phys Act 2021; 18:6. [PMID: 33413484 PMCID: PMC7791660 DOI: 10.1186/s12966-020-01072-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/14/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Early childhood is a critical period for growth and development, yet the association with physical activity during this important period is unknown. The aim of this review is to critically summarize the evidence on the prospective associations between physical activity and health and development in children aged < 5 years. METHODS A systematic search in three electronic databases (Pubmed, PsycINFO, and Sportdiscus) was conducted to identify prospective studies examining the associations between physical activity (all types; specified by quantity) and health indicators (body composition, cardiometabolic health, bone health and risks/harm) or development (motor, cognitive and social-emotional development) in young children (mean age < 5 years at baseline). Two independent researchers assessed the methodological quality using the 'Quality Assessment Tool for Quantitative Studies' (EPHPP). This tool covers eight quality criteria: selection bias, study design, confounders, blinding, data collection methods, withdrawals and drop-outs, intervention integrity and data-analysis. RESULTS Thirty-nine studies, predominantly conducted in preschoolers (ages 3-5 years), were included of which nine were rated as high methodological quality. There was moderate evidence for a positive association between physical activity and motor (n = 11 studies) and cognitive development (n = 10 studies) based on consistent findings from studies having low-to-moderate methodological quality. There was insufficient evidence for an association between physical activity and body composition (n = 15 studies), cardiometabolic health indicators (n = 7 studies), social-emotional development (n = 2 studies) and bone health (n = 2 studies) based on inconsistent findings from studies having weak-to-high methodological quality. CONCLUSIONS There is a need for more high-quality research in order to determine the dose-response relationship between physical activity and health and development in early childhood. Special attention should be paid to studies in children below the age of 3 years.
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Affiliation(s)
- Sanne L C Veldman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Mai J M Chin A Paw
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Teatske M Altenburg
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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15
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Orces CH, Orces J. Trends in the U.S. Childhood Emergency Department Visits for Fall-Related Fractures, 2001-2015. Cureus 2020; 12:e11629. [PMID: 33376643 PMCID: PMC7755699 DOI: 10.7759/cureus.11629] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective The study's objective is to examine national trends in emergency department visits for unintentional fall-related fractures among children aged 0 to 19 years between 2001 and 2015. Methods The National Electronic Injury Surveillance System - All Injury Program was used to generate national estimates of fall-related fractures treated in emergency departments. Subsequently, according to demographic characteristics, body parts, and sport activities, age-adjusted fracture rates were calculated using the 2000 U.S. population as the standard. The joinpoint regression program was used to examine the average annual percent change in fracture rates during the study period. Results An estimated 7.9 million emergency department visits for fall-related fractures among U.S. children occurred between 2001 and 2015. Overall, upper extremity fractures accounted for 70% of the cases. Trend analyses demonstrated that fracture rates markedly decreased among children aged 10 to 15 years by -2.5% (95% C: -3.4% to -1.6%) per year. After adjusting for age, boys' fracture rates decreased annually by -1.9% (95% CI: -3.1% to -0.6%), whereas the average decrease in girls was less accentuated by -1.4% (95% CI: -1.8% to -1.0%) per year. Notably, forearm/wrist fracture rates decreased annually by -2.4% (95% CI: -2.9% to -1.9%) from 2004 onwards. In contrast, head and neck fracture rates significantly increased on average by 2.6% (95% CI: 1.3% to 3.9%) per year. Conclusion Childhood emergency department visits for fall-related fractures significantly decreased in the U.S. between 2001 and 2015. However, further research is needed to determine factors related to upward trends in head/neck fractures seen during the study period.
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Affiliation(s)
| | - Jacques Orces
- Emergency Department, Nicklaus Children's Hospital, Miami, USA
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16
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Tomaru Y, Kamada H, Tsukagoshi Y, Nakagawa S, Tanaka K, Takeuchi R, Mataki Y, Kimura M, Miyakawa S, Yamazaki M. Determining the relationship between physical status and musculoskeletal injuries in children: a cohort study. J Rural Med 2020; 15:116-123. [PMID: 32704337 PMCID: PMC7369411 DOI: 10.2185/jrm.2020-015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/14/2020] [Indexed: 12/26/2022] Open
Abstract
Background: In Japan, in 2016, the School Health and Safety Act was revised and examination of extremities in addition to scoliosis became mandatory. Musculoskeletal examinations were subsequently started using a mark sheet-type questionnaire. In the present study, we aimed to analyze the relationship between physical findings and musculoskeletal problems and propose a preventive strategy for musculoskeletal injuries. Methods: In 2017, a total of 4,073 elementary and middle school students underwent direct musculoskeletal examination. In a direct examination, the following elements were included: torticollis; scoliosis; stiffness of the shoulder, elbow, hip, knee, and ankle; flexion and extension in standing position; flat foot; hallux valgus; and alignment of the upper and lower extremities. Of the 4,073 students who underwent direct examination in early 2017, only 3,754 were able to complete the mark sheet-type questionnaires in early 2018. A prospective longitudinal analysis of the data gathered was performed. Results: A total of 396 (11%) students had injuries. The ankle sprain/non-ankle sprain group comprised 119 (3%)/3,635 (97%) students, while the fracture/non-fracture group comprised 105 (2.8%)/3,650 (97.2%) students, respectively. Comparing the sprain group with the non-sprain group, ankle stiffness significantly correlated with ankle sprain in the univariable and multivariable analyses. Injuries occurred more frequently among boys, older students, students with stiff bodies, and students who were involved in sports activities of longer duration. Conclusion: Ankle stiffness was assumed to be a risk factor for ankle sprain. Stretching of the ankle might be effective for preventing ankle sprain. However, further interventional studies are needed to confirm this finding.
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Affiliation(s)
- Yohei Tomaru
- Department of Orthopaedic Surgery, Faculty of Medicine,
University of Tsukuba, Japan
| | - Hiroshi Kamada
- Department of Orthopaedic Surgery, Faculty of Medicine,
University of Tsukuba, Japan
| | - Yuta Tsukagoshi
- Department of Orthopaedic Surgery, Faculty of Medicine,
University of Tsukuba, Japan
| | - Shogo Nakagawa
- Department of Orthopaedic Surgery, Faculty of Medicine,
University of Tsukuba, Japan
| | - Kenta Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine,
University of Tsukuba, Japan
| | - Ryoko Takeuchi
- Department of Orthopaedic Surgery, Ibaraki Prefectural
University of Health Sciences Hospital, Japan
| | - Yuki Mataki
- Department of Orthopaedic Surgery, Ibaraki Prefectural
University of Health Sciences Hospital, Japan
| | - Mio Kimura
- Department of Orthopaedic Surgery, Faculty of Medicine,
University of Tsukuba, Japan
| | - Shumpei Miyakawa
- Department of Orthopaedic Surgery, Faculty of Medicine,
University of Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine,
University of Tsukuba, Japan
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17
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Jandl NM, von Kroge S, Stürznickel J, Baranowsky A, Stockhausen KE, Mushumba H, Beil FT, Püschel K, Amling M, Rolvien T. Large osteocyte lacunae in iliac crest infantile bone are not associated with impaired mineral distribution or signs of osteocytic osteolysis. Bone 2020; 135:115324. [PMID: 32198110 DOI: 10.1016/j.bone.2020.115324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/29/2020] [Accepted: 03/16/2020] [Indexed: 12/13/2022]
Abstract
The enlargement of osteocyte lacunae via osteocytic osteolysis was previously detected in situations of increased calcium demand (e.g., lactation, vitamin D deficiency). However, it is unclear whether similar processes occur also in the growing infantile skeleton and how this is linked to the mineral distribution within the bone matrix. Human iliac crest biopsies of 30 subjects (0-6 months, n = 14; 2-8 years, n = 6 and 18-25 years, n = 10) were acquired. Bone microarchitecture was assessed by micro-CT, while cellular bone histomorphometry was performed on undecalcified histological sections. Quantitative backscattered electron imaging (qBEI) was conducted to determine the bone mineral density distribution (BMDD) as well as osteocyte lacunar size and density. We additionally evaluated cathepsin K positive osteocytes using immunohistochemistry. Infantile bone was characterized by various signs of ongoing bone development such as higher bone (re)modeling, lower cortical and trabecular thickness compared to young adults. Importantly, a significantly higher osteocyte lacunar density and increased lacunar area were detected. Large osteocyte lacunae were associated with a more heterogeneous bone mineral density distribution of the trabecular bone matrix due to the presence of hypermineralized cartilage remnants, whereas the mean mineralization (i.e., CaMean) was not different in infantile bone. Absence of cathepsin K expression in osteocyte lacunae indicated nonexistent osteocytic osteolysis. Taken together, we demonstrated that the overall mineralization distribution in infantile bone is not altered compared to young adults besides high trabecular mineralization heterogeneity. Our study also provides important reference values for bone microstructure, BMDD and osteocyte characteristics in infants, children and young adults. Infantile bone displays large osteocyte lacunae indicating a developmental phenomenon rather than osteocytic osteolysis. Larger osteocytes may have superior mechanosensory abilities to enable bone adaption during growth.
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Affiliation(s)
- Nico Maximilian Jandl
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany; Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529 Hamburg, Germany
| | - Simon von Kroge
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529 Hamburg, Germany
| | - Julian Stürznickel
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529 Hamburg, Germany
| | - Anke Baranowsky
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529 Hamburg, Germany
| | - Kilian Elia Stockhausen
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529 Hamburg, Germany
| | - Herbert Mushumba
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
| | - Frank Timo Beil
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Klaus Püschel
- Department of Legal Medicine, University Medical Center Hamburg-Eppendorf, Butenfeld 34, 22529 Hamburg, Germany
| | - Michael Amling
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Tim Rolvien
- Department of Orthopedics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany; Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestr. 59, 22529 Hamburg, Germany.
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18
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Delshad M, Beck KL, Conlon CA, Mugridge O, Kruger MC, von Hurst PR. Fracture risk factors among children living in New Zealand. J Steroid Biochem Mol Biol 2020; 200:105655. [PMID: 32171787 DOI: 10.1016/j.jsbmb.2020.105655] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 12/11/2022]
Abstract
Factures are common during childhood. There are limited data available regarding relationships between bone fracture history and calcium intake, sugar sweetened beverages (SSBs) intake, vitamin D status, physical activity (PA), ethnicity, and body composition in New Zealand (NZ) children. Identifying groups of NZ children at risk of fracture and associated predictors may help to improve bone quality during childhood and decrease the risk of fractures throughout life. The aim of this study was to investigate fracture history and associated risk factors in New Zealand children. Children aged 8-12 years were recruited. Capillary blood spots collected from a finger prick were as analyzed for 25(OH)D concentrations. Bioelectrical impedance analysis (InBody720, Seoul, Korea) was used to measure body fat percentage (%BF). Information about fracture history, siblings' history of fractures, family osteoporosis history, PA, ethnicity, and intake of calcium containing foods, and SSBs was collected using questionnaires. Children (n = 647, 354 girls), mean ± SD age 9.8 ± 0.7 years were recruited from six Auckland primary schools. NZ European (n = 252) (NZE) and South Asian (n = 68) children reported the lowest (20.2 %) and highest (44.1 %) fracture incidence, respectively. NZE compared to South Asian children, had higher 25(OH)D concentrations (74.6 ± 19.8 vs. 48.4 ± 19.3 nmol/L, P < 0.001), higher total calcium intake (764.0 ± 394.4 vs. 592.7 ± 266.3 mg/d, P < 0.018), and lower %BF (19.5 ± 6.6 vs. 23.4 ± 8.4, P < 0.003). Māori children had the next highest fracture rate (32.5 %). This group had adequate 25(OH)D (64.2 ± 18.9 nmol/L), but high %BF (23.9 %) and most participated in vigorous PA. After stratifying by sex, binary logistic regression analysis revealed the main determinants of fracture history for boys were high %BF, low 25(OH)D, low calcium intake, high SSBs consumption, siblings' fracture history, family osteoporosis history, and being South Asian; and in girls, high SSBs consumption, siblings' fracture history, and family osteoporosis history. We found South Asian ethnicity was a significant risk factor for boys. Some children were at high risk of vitamin D deficiency and for whom supplementation may be necessary in winter. Good nutrition (especially good sources of calcium and reducing SSBs intakes) should be recommended to children during growth and development to reduce their risk of fractures.
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Affiliation(s)
- Maryam Delshad
- College of Health, Massey University, Auckland, New Zealand
| | - Kathryn L Beck
- College of Health, Massey University, Auckland, New Zealand
| | | | - Owen Mugridge
- College of Health, Massey University, Auckland, New Zealand
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Maillane-Vanegas S, Agostinete RR, Lynch KR, Ito IH, Luiz-de-Marco R, Rodrigues-Junior MA, Turi-Lynch BC, Fernandes RA. Bone Mineral Density and Sports Participation. J Clin Densitom 2020; 23:294-302. [PMID: 30068490 DOI: 10.1016/j.jocd.2018.05.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 11/21/2022]
Abstract
The objective of our study was to identify differences in bone mineral density (BMD) according to different sports among adolescents, as well as to identify assessments of relevant mediators. The sample consisted of 429 adolescents with a mean age of 13.3 ± 1.7 yr. The sports modalities that we evaluated were judo, karate, kung fu, swimming, basketball, and soccer. Nonsports group was composed of 111 adolescents. Bone density was assessed using dual-energy X-ray absorptiometry. Regarding BMD values, female engaged in karate had higher BMD values than girls from the no sports group (p = 0.01). Boys engaged in soccer and karate presented the highest BMD values than all the other groups (p = 0.01). The most relevant mediators were the body mass index and lean soft tissue for boys and girls. Different sports presented different results regarding BMD gains, which were influenced by body mass index and whole-body lean soft tissue.
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Affiliation(s)
- Santiago Maillane-Vanegas
- Post-Graduate Program in Physiotherapy, Department of Physiotherapy, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Laboratory of InVestigation in Exercise - LIVE, Scientific Research Group Related to Physical Activity (GICRAF), Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, Brazil.
| | - Ricardo R Agostinete
- Post-Graduate Program in Physiotherapy, Department of Physiotherapy, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Laboratory of InVestigation in Exercise - LIVE, Scientific Research Group Related to Physical Activity (GICRAF), Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Post-Graduate Program in Kinesiology, Institute of Bioscience, Sao Paulo State University (UNESP), Rio Claro, Brazil
| | - Kyle R Lynch
- Laboratory of InVestigation in Exercise - LIVE, Scientific Research Group Related to Physical Activity (GICRAF), Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Post-Graduate Program in Kinesiology, Institute of Bioscience, Sao Paulo State University (UNESP), Rio Claro, Brazil
| | - Igor H Ito
- Laboratory of InVestigation in Exercise - LIVE, Scientific Research Group Related to Physical Activity (GICRAF), Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Post-Graduate Program in Kinesiology, Institute of Bioscience, Sao Paulo State University (UNESP), Rio Claro, Brazil
| | - Rafael Luiz-de-Marco
- Post-Graduate Program in Physiotherapy, Department of Physiotherapy, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Laboratory of InVestigation in Exercise - LIVE, Scientific Research Group Related to Physical Activity (GICRAF), Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, Brazil
| | - Mario A Rodrigues-Junior
- Laboratory of InVestigation in Exercise - LIVE, Scientific Research Group Related to Physical Activity (GICRAF), Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Post-Graduate Program in Kinesiology, Institute of Bioscience, Sao Paulo State University (UNESP), Rio Claro, Brazil
| | - Bruna Camilo Turi-Lynch
- Laboratory of InVestigation in Exercise - LIVE, Scientific Research Group Related to Physical Activity (GICRAF), Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Post-Graduate Program in Kinesiology, Institute of Bioscience, Sao Paulo State University (UNESP), Rio Claro, Brazil
| | - Rômulo A Fernandes
- Post-Graduate Program in Physiotherapy, Department of Physiotherapy, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Laboratory of InVestigation in Exercise - LIVE, Scientific Research Group Related to Physical Activity (GICRAF), Department of Physical Education, Sao Paulo State University (UNESP), Presidente Prudente, Brazil; Post-Graduate Program in Kinesiology, Institute of Bioscience, Sao Paulo State University (UNESP), Rio Claro, Brazil
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20
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Lempesis V, Jerrhag D, Rosengren BE, Landin L, Tiderius CJ, Karlsson MK. Pediatric Distal Forearm Fracture Epidemiology in Malmö, Sweden-Time Trends During Six Decades. J Wrist Surg 2019; 8:463-469. [PMID: 31815060 PMCID: PMC6892656 DOI: 10.1055/s-0039-1692471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 05/09/2019] [Indexed: 12/18/2022]
Abstract
Background The distal forearm fracture is the most common fracture in children. To allocate health care resources and evaluate if prevention strategies have been successful, it is essential to monitor changes in the epidemiology of common fractures. Methods Our hospital serves a city in which year 2006 included 276,244 inhabitants (49,664 <17 years of age). Through the hospital archives, we identified fractures sustained by individuals younger than 16 years during 2005 and 2006 and compared these with previous collected and published data from the same area and hospital for the period 1950 to 1994. We used official population data to estimate period-specific fracture rates and age and gender standardized time trends. We report rates as number of fractures per 100,000 person-years and changes between periods as rate ratios (RR) with 95% confidence intervals (CIs). Results We identified 521 distal forearm fractures, corresponding to a crude fracture incidence of 564/100,000 person-years (boys 719; girls 401). Age-adjusted fracture incidence was 70% higher in boys than in girls (RR 1.7; 95% CI 1.3-2.3). The age- and gender-adjusted hand fracture incidence was 40% higher in 2005-2006 than in 1950/1955 (RR 1.4; 95% CI 1.2 to 1.8) but no higher than 1993-1994 (RR 1.1; 95% CI 0.9-1.3). Fracture etiology of 2005 to 2006 included sports injuries in 41% and traffic accidents in 11% of the cases, while sports injuries explained 37% and traffic accidents 18% in 1950 to 1955. Conclusion In 2005 to 2006, we found higher rates in boys and higher overall rates compared with the 1950s but no significant differences compared with the rates in 1993 to 1994. Future studies should include patient-specific data to unravel causal factors. Level of evidence This is a Level III b study.
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Affiliation(s)
- Vasileios Lempesis
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skane University Hospital, Malmo, Sweden
| | - Daniel Jerrhag
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skane University Hospital, Malmo, Sweden
| | - Björn E. Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skane University Hospital, Malmo, Sweden
| | - Lennart Landin
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skane University Hospital, Malmo, Sweden
| | - Carl Johan Tiderius
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skane University Hospital, Malmo, Sweden
| | - Magnus K. Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skane University Hospital, Malmo, Sweden
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Tobias JH, Fairbank J, Harding I, Taylor HJ, Clark EM. Association between physical activity and scoliosis: a prospective cohort study. Int J Epidemiol 2019; 48:1152-1160. [PMID: 30535285 PMCID: PMC6896242 DOI: 10.1093/ije/dyy268] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Little is understood about the causes of adolescent onset idiopathic scoliosis (AIS). No prospective studies assessing the association between physical activity and idiopathic adolescent scoliosis have been carried out. We aimed to carry out the first prospective population-based study of this association. METHODS The Avon Longitudinal Study of Parents and Children (ALSPAC) collected self-reported measures of physical ability/activity at ages 18 months and 10 years. Objective measures of physical activity were collected by accelerometry at age 11 years. scoliosis was identified using the dxa scoliosis Method at age 15 years. Participants with scoliosis at age 10 years were excluded. RESULTS Of 4640 participants at age 15 years who had DXA scans, 267 (5.8%) had scoliosis. At age 18 months, those infants who were able to stand up without being supported were 66% less likely to have developed scoliosis by age 15 (P = 0.030) compared with infants who could not. Those children whose mothers reported they did most vigorous physical activity at age 10 years were 53% less likely to develop scoliosis (P = 0.027). Those children who did more objectively measured moderate/vigorous physical activity at age 11 were 30% less likely to have developed scoliosis (P < 0.001). Results were not affected by adjustment for age, gender, lean mass, fat mass or back pain. CONCLUSIONS We report reduced physical ability and activity as early as age 18 months in those who go on to develop scoliosis by age 15 years. Further research is justified to examine the mechanisms underlying this association.
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Affiliation(s)
- Jon H Tobias
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, UK
| | - Jeremy Fairbank
- Nuffield Department of Orthopaedics, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
| | - Ian Harding
- Musculoskeletal Directorate, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Hilary J Taylor
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, UK
| | - Emma M Clark
- Musculoskeletal Research Unit, University of Bristol, Southmead Hospital, Bristol, UK
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Lempesis V, Rosengren BE, Landin L, Tiderius CJ, Karlsson MK. Hand fracture epidemiology and etiology in children-time trends in Malmö, Sweden, during six decades. J Orthop Surg Res 2019; 14:213. [PMID: 31299998 PMCID: PMC6626361 DOI: 10.1186/s13018-019-1248-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 06/25/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The aim of this study was to describe hand fracture epidemiology/etiology in city children and describe time trend during six decades. PATIENTS AND METHODS A single hospital serves the entire city population of 271,271 (year 2005). Through the hospital medical and radiological archives, we collected epidemiology and etiology data concerning pediatric (age < 16 years) hand fractures in city residents, treated during 2005-2006. We compared these data to previously collected data in in the same city during 12 evaluated periods from 1950/1955 to 1993-1994. We present period-specific crude and age- and gender-adjusted fracture incidence rates and group differences as incidence rate ratios (RR) with 95% confidence intervals (95% CI). RESULTS In 2005-2006, we identified 414 hand fractures (303 in boys and 111 in girls), 247 phalangeal fractures (60% of all hand fractures), 140 metacarpal/carpal fractures (except the scaphoid bone) (34%), and 27 scaphoid fractures (6%). The crude hand fracture rate in children was 448/100,000 person years (639/100,000 in boys and 247/100,000 in girls), with a 2.5 times higher age-adjusted incidence in boys than in girls. Compared to 1950/1955, the age and gender-adjusted hand fracture incidence was twice as high in 2005-2006 and more than twice as high in 1976-1979. Compared to 1976-1979, we found no significant difference in the age and gender-adjusted hand fracture incidence in 2005-2006. In 2005-2006, sports injuries explained 42%, fights 20%, and traffic accidents 13% of the hand fractures. In 1950/1955, sports injuries explained 27% of fractures, fights 10%, and traffic accidents 21%. CONCLUSIONS The incidence of hand fractures in children was more than twice as high in the end of the 1970s compared to the 1950s, where after no significant change could be found. Also, fracture etiology has changed. New studies are needed, to adequately allocate health care resources and identify new fracture prone activities suitable for preventive measures. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Vasileios Lempesis
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden.
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Lennart Landin
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Carl Johan Tiderius
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, SE-205 02, Malmö, Sweden
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Grgic O, Chung K, Shevroja E, Trajanoska K, Uitterlinden AG, Wolvius EB, Rivadeneira F, Medina-Gomez C. Fractures in school age children in relation to sex and ethnic background: The Generation R Study. Bone 2019; 121:227-231. [PMID: 30677542 DOI: 10.1016/j.bone.2019.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/07/2019] [Accepted: 01/16/2019] [Indexed: 11/30/2022]
Abstract
Fracture rate in childhood is increasing and its consequences may affect health and developmental processes and cause school absence and restricted activity days. There are scarce epidemiologic studies regarding fractures in children. The aim of this study was to evaluate if pediatric fractures show disparities across sexes and ethnic groups. This study was conducted based on data from 3632 participants of the Generation R Study. Prevalent fractures were assessed using a questionnaire at a mean age of 9.7 years. Child's ethnicity was determined based on country of birth of the parents using questionnaires (geographic ancestry) or admixture analysis (genetic ancestry). Associations between fracture occurrence and sex or ethnicity were evaluated using logistic regression models adjusted for age, weight, lean mass fraction, bone mineral density (BMD) and sex/ethnicity. Fracture was reported for 525 (14.5%) children. The great majority of these children were classified as European (N = 3164), followed by African (N = 283) and Asian (N = 185) based on geographic ancestry. Similarly, the highest proportion of Europeans was observed based on genetic ancestry. Prevalence of fractures was not different between boys and girls, even after adjustment for possible confounders (OR: 1.03, 95% CI 0.84-1.27, p-value = 0.8). However, odds of prevalent fractures were two times higher in European when compared to Asian children (OR: 2.01, 95% CI 1.17-3.45, p-value = 0.01), and 1.5 times higher when compared to African children (OR: 1.50, 95% CI 1.00-2.26, p-value = 0.05). Overall, in this study, European children showed a highest risk of prevalent fractures independently of factors such as body composition and BMD, while no difference in the prevalence of fractures between boys and girls was observed.
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Affiliation(s)
- Olja Grgic
- Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Internal Medicine, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Maxillo-Facial Surgery, Special Dental Care and Orthodontics, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, The Generation R Study, the Netherlands
| | - Kuan Chung
- Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, The Generation R Study, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Epidemiology, the Netherlands.
| | - Enisa Shevroja
- Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Internal Medicine, the Netherlands.
| | - Katerina Trajanoska
- Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Internal Medicine, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Epidemiology, the Netherlands.
| | - Andre G Uitterlinden
- Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Internal Medicine, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, The Generation R Study, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Epidemiology, the Netherlands.
| | - Eppo B Wolvius
- Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Maxillo-Facial Surgery, Special Dental Care and Orthodontics, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, The Generation R Study, the Netherlands.
| | - Fernando Rivadeneira
- Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Internal Medicine, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, The Generation R Study, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Epidemiology, the Netherlands.
| | - Carolina Medina-Gomez
- Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Internal Medicine, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, The Generation R Study, the Netherlands; Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Department of Epidemiology, the Netherlands.
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Mamoowala N, Johnson NA, Dias JJ. Trends in paediatric distal radius fractures: an eight-year review from a large UK trauma unit. Ann R Coll Surg Engl 2019; 101:297-303. [PMID: 30855170 PMCID: PMC6432966 DOI: 10.1308/rcsann.2019.0023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This observational study investigated the incidence of distal radius fractures in children, to determine whether the rate is rising, the effect of seasonal variation on incidence and whether fracture type and rate of surgical intervention has changed, to help in determining costs for secondary care and to aid resource allocation. MATERIALS AND METHODS All paediatric patients(n = 6529) who sustained a distal radius fracture over an eight-year period (2007-2014) were identified. Poisson regression modelling was used to identify change in trends. RESULTS There was no change in distal radius fracture incidence, rate of surgical intervention (P = 0.36) or fracture type (P = 0.70). Overall incidence was 337 fractures per 100,000 patient/years. The highest fracture incidence was seen in older school boys (708 per 100,000 patient/years, P < 0.005). Overall fracture rate was lower in winter (P < 0.005). Incidence is highest in summer and the main variation is related to season. DISCUSSION These data can help to predict accurately the number of children presenting to the emergency department with wrist fractures depending on the time of year.
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Affiliation(s)
- N Mamoowala
- Department of Trauma and Orthopaedics, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
| | - NA Johnson
- Department of Trauma and Orthopaedics, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
| | - JJ Dias
- Department of Trauma and Orthopaedics, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
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Magan A, Micklesfield LK, Norris SA, Thandrayen K, Munthali RJ, Pettifor JM. Metacarpal Indices and Their Association with Fracture in South African Children and Adolescents. Calcif Tissue Int 2019; 104:14-25. [PMID: 30167746 DOI: 10.1007/s00223-018-0467-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/14/2018] [Indexed: 10/28/2022]
Abstract
This prospective study assessed whether metacarpal indices predict fracture risk in children and adolescents. Radiogrammetry was performed at the second metacarpal midshaft on annual hand-wrist radiographs of 359 South African (SA) children aged 10-17 years. Bone length, bone width, and medullary width were measured, and the following proxies for bone strength calculated: metacarpal index (MCI), bone mineral density (BMD), section modulus (SM), stress-strain index (SSI), and slenderness index (SLI). Height and weight were measured annually. Self-reported physical activity (PA) and fracture history were obtained at ages 15 years (for the preceding 12 months) and 17 years, respectively. At 17 years, 82 (23%) participants (black, 16%; white, 42%; p < 0.001) reported a previous fracture. None of the bone measures or indices were associated with fracture in black participants. In white females, after adjusting for PA, a 1 standard deviation (SD) greater SLI doubled the fracture risk [odds ratio (OR) 2.08; 95% confidence interval (CI) 1.08, 3.98]. In white males, a 1 SD greater BMD was associated with a 2.62-fold increase in fracture risk (OR 3.62; 95% CI 1.22, 10.75), whilst a 1 SD greater SM (OR 2.29; 95% CI 1.07, 4.89) and SSI (OR 2.23; 95% CI 1.11, 4.47) were associated with a more than twofold increase in fracture risk, after height, and PA adjustment. No single index consistently predicted fracture across the four groups possibly due to ethnic and sex differences in bone geometry, muscle mass, and skeletal loading. Metacarpal radiogrammetry did not reliably predict fracture in SA children.
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Affiliation(s)
- A Magan
- South African MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193, South Africa.
| | - L K Micklesfield
- South African MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193, South Africa
| | - S A Norris
- South African MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193, South Africa
| | - K Thandrayen
- South African MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193, South Africa
| | - R J Munthali
- South African MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193, South Africa
| | - J M Pettifor
- South African MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2193, South Africa
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Segal D, Slevin O, Aliev E, Borisov O, Khateeb B, Faour A, Palmanovich E, Brin YS, Weigl D. Trends in the seasonal variation of paediatric fractures. J Child Orthop 2018; 12:614-621. [PMID: 30607209 PMCID: PMC6293327 DOI: 10.1302/1863-2548.12.180114] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The incidence of paediatric fractures is known to peak during the summer as a consequence of unsupervised physical activity. A more sedentary lifestyle is a potential cause for changes in paediatric seasonal fracture frequency and severity. The aim of this study was to evaluate the current seasonal variations of paediatric fractures in order to determine resource allocation in hospitals, community clinics and prevention programs. METHODS A single institutional review of historical data of all patients aged 0 to 16 years that were diagnosed with fractures between April 2014 and July 2017 in the emergency department of a level 3 orthopaedic trauma centre was conducted. In all, 3484 fractures were reviewed, of which 2991 were included. We stratified fractures according to patients' variants and the hour, day and month with respect to holidays, weekends and weather. RESULTS While the fracture rate on school days was 6.62 per day, the fracture rate during the summer vacation was 4.45 (p < 0.01). Hot weather was correlated with low fracture rates. The peak hours of admission were 12:00 to 13:00 and 18:00 to 22:00, with more moderate differences during non-school periods. CONCLUSION The local seasonal variation of paediatric fractures has a bimodal distribution, with similar nadirs during both summer and winter. These rates might reflect a shift to a more sedentary lifestyle during the summer vacation. The presented data can assist in improving the value of injury prevention measures and medical resources allocation. LEVEL OF EVIDENCE II.
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Affiliation(s)
- D. Segal
- Department of Orthopaedic Surgery, Meir Medical Center, Kfar Saba, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel, Correspondence should be sent to David Segal, Department of Orthopaedic Surgery, Meir Medical Center, 59 Tshernichovsky St., Kfar Saba, 4428164Israel. E-mail:
| | - O. Slevin
- Department of Orthopaedic Surgery, Meir Medical Center, Kfar Saba, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - E. Aliev
- Department of Orthopaedic Surgery, Meir Medical Center, Kfar Saba, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - O. Borisov
- Department of Orthopaedic Surgery, Meir Medical Center, Kfar Saba, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - B. Khateeb
- Department of Orthopaedic Surgery, Meir Medical Center, Kfar Saba, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - A. Faour
- Department of Orthopaedic Surgery, Meir Medical Center, Kfar Saba, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - E. Palmanovich
- Department of Orthopaedic Surgery, Meir Medical Center, Kfar Saba, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - Y. S. Brin
- Department of Orthopaedic Surgery, Meir Medical Center, Kfar Saba, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel
| | - D. Weigl
- Department of Orthopaedic Surgery, Schneider’s Children’s Hospital, Rabin Medical Center, Israel, affiliated with Tel Aviv University, Tel Aviv, Israel
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Sarinho ESC, Melo VMPP, Viana MT, Melo MMP. IS THERE AN ASSOCIATION BETWEEN GLUCOCORTICOID USE AND FRACTURES? A COMPARATIVE STUDY IN A TRAUMA HOSPITAL. ACTA ACUST UNITED AC 2018; 37:4-10. [PMID: 30066821 PMCID: PMC6362371 DOI: 10.1590/1984-0462/;2019;37;1;00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 10/18/2017] [Indexed: 11/21/2022]
Abstract
Objective: To assess the association between traumatic fractures and glucocorticoids taken 12 months prior to a trauma, in children and adolescents seen at an emergency room. Methods: A case-control study was conducted from April to October 2015, at a pediatric emergency hospital with patients aged 3- to 14 years-old, who had suffered physical trauma. Some of the patients had a fracture and some did not. The data analyzed were obtained from medical records, physical examination of the patients, and interview with the patients’ caregivers. Glucocorticoid use in the past 12 months, demographic variables, body mass index, milk intake, trauma intensity, physical activity and smoking in the household were compared between the two patient groups. Results: A total of 104 patients with physical trauma were studied - 50 had a fracture and 54 did not. Of all the patients, 15.4% had previously used glucocorticoids, and there were no statistically significant differences between the groups. The age range of 10- to 14 years-old, severe trauma and physical activity were more prevalent among patients with a bone fracture. Conclusions: This study did not find an association between previous glucocorticoid use and the occurrence of fractures in children and adolescents. The age range of 10- to 14 years-old, severe trauma, and physical activity were associated with an increased risk for fractures.
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Wasserman H, Backeljauw PF, Khoury JC, Kalkwarf HJ, Gordon CM. Bone fragility in Turner syndrome: Fracture prevalence and risk factors determined by a national patient survey. Clin Endocrinol (Oxf) 2018; 89:46-55. [PMID: 29658144 DOI: 10.1111/cen.13614] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/02/2018] [Accepted: 04/04/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Osteoporosis is considered a comorbidity of adult women with Turner syndrome (TS). Limited data are available on fracture prevalence in girls and women with this diagnosis. We aimed to determine the prevalence of fractures in individuals with TS in the United States and identify risk factors for fracture. DESIGN Girls and women with TS were invited to participate in an anonymous, self-report, national survey from November 2016 to March 2017. Non-TS controls were obtained through direct contacts of TS participants. RESULTS During childhood (0-12 years), adolescence (13-25 years) and young adulthood (26-45 years), there was no difference between TS and controls in fracture prevalence. Girls and women with TS were more likely to report upper extremity fractures, whereas controls were more likely to report phalangeal fractures. Older women (>45 years) with TS were more likely to fracture than non-TS controls (P = .01). Balance problems were more common in individuals with TS than controls (26.5% vs 14.8%, P = .0006). In TS, those reporting balance problems were 54% more likely to have a prior fracture than those without balance problems (OR=1.54, 95% CI 1.03, 2.30), even after controlling for age. There was no significant association between balance problems and fractures among controls. CONCLUSIONS In a nationwide survey, there was no difference in fracture prevalence in younger women with TS compared with controls. However, the location of fractures differed. After controlling for age, impaired balance was associated with an increased fracture risk in TS and may be an underrecognized risk factor for fracture in this population.
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Affiliation(s)
- Halley Wasserman
- Division of Endocrinology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Philippe F Backeljauw
- Division of Endocrinology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jane C Khoury
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Heidi J Kalkwarf
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Catherine M Gordon
- Division of Endocrinology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Division of Adolescent and Transition Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Appendicular fracture epidemiology of children and adolescents: a 10-year case review in Western Australia (2005 to 2015). Arch Osteoporos 2018; 13:63. [PMID: 29860609 DOI: 10.1007/s11657-018-0478-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/15/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED Fracture incidence data of Australian children and adolescents have not been reported in the literature. A 10-year case review of fracture presentations in Western Australia is provided. Between 2005 and 2015, fracture incidence increased relative to population growth. This is concerning, and interventions are required to reverse this trend. PURPOSE Fracture incidence in 0-16-year-olds is high and varies between countries. Boys have a 1.5:1 ratio of fracture incidence compared to girls. There are no specific data for Australia. Western Australia is a state with unique geography and population distribution having only a single tertiary paediatric hospital (Princess Margaret Hospital, PMH, in Perth) managing the majority of children and adolescents with fractures in the Emergency Department (ED). The aims of this study were to characterise fracture presentations to PMH-ED and compare the incidence to population data. METHODS A database audit of fracture presentations between 2005 and 2015 for fracture rates with a sub-analysis for gender, fracture site and age and a comparison to Perth Metropolitan and Western Australian population data was performed. RESULTS Analysis included 31,340 presentations. Fracture incidence, adjusted for the annual population size, increased from 0.63% in 2005 to 0.85% in 2015 (p < 0.001). The month of May reported the highest fracture rate (p < 0.001) corresponding with the start of the winter sports season. Males had a 1.5 times higher fracture incidence than females (p < 0.001), with upper limb fractures three times more common than lower limb fractures (p < 0.001). Fracture incidence increased with age until the early teenage years (15 years for males; 12 years for females) when a decline occurred. CONCLUSIONS Increased fracture incidence in Western Australia between 2005 and 2015 identifies a concerning trend for bone health in children and adolescents. Further research is needed to identify potential lifestyle factors that impact fracture incidence translating into evidence-based strategies to reverse these trends and improve bone health.
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Karpiński M, Popko J, Maresz K, Badmaev V, Stohs SJ. Roles of Vitamins D and K, Nutrition, and Lifestyle in Low-Energy Bone Fractures in Children and Young Adults. J Am Coll Nutr 2018; 36:399-412. [PMID: 28686548 DOI: 10.1080/07315724.2017.1307791] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The research on skeletal system health in children and young adults, while recognizing the important role of calcium and vitamin D, goes beyond these nutritional standards. This review focuses on the role of vitamin K in combination with vitamin D and other factors in bone health. The current understanding is that maintaining bone health and prevention of low-energy fractures in any pediatric population includes nutritional factors combined with an active lifestyle. Calcium, vitamin D, and vitamin K supplementation contribute independently and collectively to bone health. The beneficial role of vitamin K, particularly vitamin K2 as menaquinone-7 (MK-7), in bone and cardiovascular health is reasonably well supported scientifically, with several preclinical, epidemiological, and clinical studies published over the last decade. Osteocalcin and matrix-Gla (glutamate-containing) protein (MGP) exemplify vitamin K-dependent proteins involved in building bone matrix and keeping calcium from accumulating in the arterial walls, respectively. An important part of the mechanism of vitamin K involves carboxylation and posttranslational activation of the family of vitamin K-dependent proteins, which prevent expression of pro-inflammatory factors and support improvement in bone mineral concentration, bone mineral density, and the quality of bone matrix. Understanding the combined approach to a healthy skeletal system in children and young adults, including the roles of vitamins D and K, calcium, healthy diet, and exercise, is particularly important in view of reports of subclinical insufficiency of vitamins D and K in otherwise healthy pediatric populations with low-energy bone fractures.
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Affiliation(s)
- Michał Karpiński
- a Department of Pediatric Orthopedics and Traumatology Medical University of Bialystok , Bialystok , Poland
| | - Janusz Popko
- b Medical Institute of the State College of Computer Science and Business Administration , Łomża , Poland
| | | | | | - Sidney J Stohs
- e Creighton University Medical Center , Omaha , Nebraska
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Christoffersen T, Emaus N, Dennison E, Furberg AS, Gracia-Marco L, Grimnes G, Nilsen OA, Vlachopoulos D, Winther A, Ahmed LA. The association between childhood fractures and adolescence bone outcomes: a population-based study, the Tromsø Study, Fit Futures. Osteoporos Int 2018; 29:441-450. [PMID: 29147750 PMCID: PMC6124640 DOI: 10.1007/s00198-017-4300-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
UNLABELLED Childhood fracture may predict persistent skeletal fragility, but it may also reflect high physical activity which is beneficial to bone development. We observe a difference in the relationship between previous fracture and bone outcome across physical activity level and sex. Further elaboration on this variation is needed. PURPOSE Childhood fracture may be an early marker of skeletal fragility, or increased levels of physical activity (PA), which are beneficial for bone mineral accrual. This study investigated the association between a previous history of childhood fracture and adolescent bone mineral outcomes by various PA levels. METHODS We recruited 469 girls and 492 boys aged 15-18 years to this study. We assessed PA levels by questionnaire and measured areal bone mineral density (aBMD) and bone mineral content (BMC) using dual-energy X-ray absorptiometry (DXA) at arm, femoral neck (FN), total hip (TH), and total body (TB) and calculated bone mineral apparent density (BMAD, g/cm3). Fractures from birth to time of DXA measurements were retrospectively recorded. We analyzed differences among participants with and without fractures using independent sample t test. Multiple linear regression was used to examine the association between fractures and aBMD and BMC measurements according to adolescent PA. RESULTS Girls with and without a previous history of fracture had similar BMC, aBMD, and BMAD at all sites. In multiple regression analyses stratified by physical activity intensity (PAi), there was a significant negative association between fracture and aBMD-TH and BMC-FN yet only in girls reporting low PAi. There was a significant negative association between forearm fractures, BMAD-FN, and BMAD-arm among vigorously active boys. CONCLUSION Our findings indicate a negative association between childhood fractures and aBMD/BMC in adolescent girls reporting low PAi. In boys, such an association appears only in vigorously active participants with a history of forearm fractures.
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Affiliation(s)
- T Christoffersen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Forskningsparken, Sykehusveien 21, 9037, Tromsø, Norway.
- Finnmark Hospital Trust, Alta, Norway.
| | - N Emaus
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Forskningsparken, Sykehusveien 21, 9037, Tromsø, Norway
| | - E Dennison
- MRC Lifecourse Epidemiology Unit, Southampton, UK
- Victoria University, Wellington, New Zealand
| | - A-S Furberg
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - L Gracia-Marco
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Growth, Exercise, Nutrition and Development Research Group, University of Zaragoza, Zaragoza, Spain
| | - G Grimnes
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway
- Tromsø Endocrine Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - O A Nilsen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Forskningsparken, Sykehusveien 21, 9037, Tromsø, Norway
| | - D Vlachopoulos
- Children's Health and Exercise Research Centre, Sport and Health Sciences, University of Exeter, Exeter, UK
| | - A Winther
- Division of Neurosciences, Orthopedics and Rehabilitation Services, University Hospital of North Norway, Tromsø, Norway
| | - L A Ahmed
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Forskningsparken, Sykehusveien 21, 9037, Tromsø, Norway
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
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Gray N, Howard A, Zhu J, Feldman LY, To T. Association Between Inhaled Corticosteroid Use and Bone Fracture in Children With Asthma. JAMA Pediatr 2018; 172:57-64. [PMID: 29131874 PMCID: PMC5833516 DOI: 10.1001/jamapediatrics.2017.3579] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Daily use of inhaled corticosteroids is a widely recommended treatment for mild persistent asthma in children. There is concern that, similar to systemic corticosteroids, inhaled corticosteroids may have adverse effects on bone health. OBJECTIVE To determine whether there is an increased risk of bone fracture associated with inhaled corticosteroid use in children with asthma. DESIGN, SETTING, AND PARTICIPANTS In this population-based nested case-control study, we used health administrative databases to identify a cohort of children aged 2 to 18 years with a physician diagnosis of asthma between April 1, 2003, and March 31, 2014, who were eligible for public drug coverage through the Ontario Drug Benefit Program (Ontario, Canada). We matched cases of first fracture after asthma diagnosis to fracture-free controls (ratio of 1 to 4) based on date of birth (within 1 year), sex, and age at asthma diagnosis (within 2 years). We used a 1-year lookback period to ascertain history of inhaled corticosteroid use. Multivariable conditional logistic regression was used to obtain an odds ratio (OR) with 95% confidence interval for fracture, comparing no inhaled corticosteroid use vs current, recent, and past use. EXPOSURES Inhaled corticosteroid use during the child's 1-year lookback period, measured as current user if the prescription was filled less than 90 days prior to the index date, recent user (91-180 days), past user (181-365 days), or no use. MAIN OUTCOMES AND MEASURES First emergency department visit for fracture after asthma diagnosis, identified using International Statistical Classification of Diseases and Related Health Problems, 10th Revision codes. RESULTS This study included 19 420 children (61.0% male; largest proportion of children, 31.5%, were aged 6-9 years at their index date). The multivariable regression results did not show a significant association between first fracture after asthma diagnosis and current use (OR, 1.07; 95% CI, 0.97-1.17), recent use (OR, 0.96; 95% CI, 0.86-1.07), or past use (OR, 1.00; 95% CI, 0.91-1.11) of inhaled corticosteroids, compared with no use, while adjusting for sociodemographic factors and other medication use. However, use of systemic corticosteroids in the 1-year lookback period resulted in greater odds of fracture (OR, 1.17; 95% CI, 1.04-1.33). CONCLUSIONS AND RELEVANCE Systemic corticosteroids, but not inhaled corticosteroids, were significantly associated with increased odds of fracture in the pediatric asthma population.
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Affiliation(s)
- Natasha Gray
- The Hospital for Sick Children, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Howard
- The Hospital for Sick Children, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Jingqin Zhu
- The Hospital for Sick Children, Toronto, Ontario, Canada,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Teresa To
- The Hospital for Sick Children, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Carson V, Lee EY, Hewitt L, Jennings C, Hunter S, Kuzik N, Stearns JA, Unrau SP, Poitras VJ, Gray C, Adamo KB, Janssen I, Okely AD, Spence JC, Timmons BW, Sampson M, Tremblay MS. Systematic review of the relationships between physical activity and health indicators in the early years (0-4 years). BMC Public Health 2017; 17:854. [PMID: 29219090 PMCID: PMC5753397 DOI: 10.1186/s12889-017-4860-0] [Citation(s) in RCA: 317] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Given the rapid development during the early years (0-4 years), an understanding of the health implications of physical activity is needed. The purpose of this systematic review was to examine the relationships between objectively and subjectively measured physical activity and health indicators in the early years. Methods Electronic databases were originally searched in April, 2016. Included studies needed to be peer-reviewed, written in English or French, and meet a priori study criteria. The population was apparently healthy children aged 1 month to 59.99 months/4.99 years. The intervention/exposure was objectively and subjectively measured physical activity. The comparator was various volumes, durations, frequencies, patterns, types, and intensities of physical activity. The outcomes were health indicators ranked as critical (adiposity, motor development, psychosocial health, cognitive development, fitness) and important (bone and skeletal health, cardiometabolic health, and risks/harm). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to assess the quality of evidence for each health indicator by each study design. Results Ninety-six studies representing 71,291 unique participants from 36 countries were included. Physical activity interventions were consistently (>60% of studies) associated with improved motor and cognitive development, and psychosocial and cardiometabolic health. Across observational studies, physical activity was consistently associated with favourable motor development, fitness, and bone and skeletal health. For intensity, light- and moderate-intensity physical activity were not consistently associated with any health indicators, whereas moderate- to vigorous-intensity, vigorous-intensity, and total physical activity were consistently favourably associated with multiple health indicators. Across study designs, consistent favourable associations with health indicators were observed for a variety of types of physical activity, including active play, aerobic, dance, prone position (infants; ≤1 year), and structured/organized. Apart from ≥30 min/day of the prone position for infants, the most favourable frequency and duration of physical activity was unclear. However, more physical activity appeared better for health. Evidence ranged from “very low” to “high” quality. Conclusions Specific types of physical activity, total physical activity, and physical activity of at least moderate- to vigorous-intensity were consistently favourably associated with multiple health indicators. The majority of evidence was in preschool-aged children (3-4 years). Findings will inform evidence-based guidelines. Electronic supplementary material The online version of this article (10.1186/s12889-017-4860-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Valerie Carson
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, T6G 2H9, Canada.
| | - Eun-Young Lee
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, T6G 2H9, Canada
| | - Lyndel Hewitt
- Early Start Research Institute, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - Cally Jennings
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, T6G 2H9, Canada
| | - Stephen Hunter
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, T6G 2H9, Canada
| | - Nicholas Kuzik
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, T6G 2H9, Canada
| | - Jodie A Stearns
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, T6G 2H9, Canada
| | - Stephanie Powley Unrau
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, T6G 2H9, Canada
| | - Veronica J Poitras
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada
| | - Casey Gray
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada
| | - Kristi B Adamo
- School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, K1N 1A2, Canada
| | - Ian Janssen
- School of Kinesiology and Health Studies, and Department of Public Health Sciences, Queen's University, Kingston, ON, K7L 3N6, Canada
| | - Anthony D Okely
- Early Start Research Institute, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, 2522, Australia
| | - John C Spence
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, T6G 2H9, Canada
| | - Brian W Timmons
- Child Health & Exercise Medicine Program, Department of Pediatrics, McMaster University, Hamilton, ON, L8S 4K1, Canada
| | - Margaret Sampson
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada.,Library and Media Services, Children's Hospital of Eastern Ontario, Ottawa, ON, K1H 8L1, Canada
| | - Mark S Tremblay
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, K1H 8L1, Canada
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Chevalley T, Bonjour JP, Audet MC, Merminod F, van Rietbergen B, Rizzoli R, Ferrari S. Fracture Prospectively Recorded From Prepuberty to Young Adulthood: Are They Markers of Peak Bone Mass and Strength in Males? J Bone Miner Res 2017; 32:1963-1969. [PMID: 28543781 DOI: 10.1002/jbmr.3174] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/22/2017] [Accepted: 05/22/2017] [Indexed: 11/05/2022]
Abstract
Fractures are common in otherwise healthy children and adolescents. They result from trauma of varying severity. Some reflect a greater skeletal fragility. A long-term implication of these fractures is their potentiality to predict adult bone fragility and increased risk of osteoporosis in later life. Using dual-energy X-ray absorptiometry (DXA), high-resolution peripheral quantitative computed tomography (HR-pQCT), and micro-finite element analysis (μFEA) measurements, we previously found in 124 healthy females, followed from the age of 7.9 to 20.4 years, substantial deficits in both structural and strength components of the radius in the 42 girls who sustained a fracture during skeletal development. The objective of the current study was to assess in healthy males the relationship between fracture during development and expression of bone fragility in adulthood. A cohort of 152 boys was followed from age 7.4 ± 04 (mean ± SD) to 22.6 ± 0.7 years, ie, when peak bone mass is attained. Ninety participants (59.2%) sustained at least one fracture during growth, with highest incidence within the 10- to 13-year age range. Forearm was the most frequent site of fractures. At 7.4 years, several bone DXA-measured variables (areal bone mineral density [aBMD], bone mineral content [BMC]) were lower in the group with a positive fracture history during skeletal development compared with the non-fractured group. In contrast, at 22.6 years, no DXA-measured sites, including forearm, indicated a deficit in the fractured group compared with the non-fractured group. Likewise, at 22.6 years, neither HR-pQCT nor μFEA measurements, including distal radius, showed a structural or strength deficit in the fractured group. These results markedly contrast with a similar prospective study using the same technical and clinical design in 124 healthy girls. In conclusion, our prospective studies suggest a sex difference in the predictability of bone fragility in young adults who sustained fractures during childhood and adolescence. This difference might be related to the degree of trauma severity, usually lower in girls than in boys. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Thierry Chevalley
- Division of Bone Diseases, University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jean-Philippe Bonjour
- Division of Bone Diseases, University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marie-Claude Audet
- Division of Bone Diseases, University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Fanny Merminod
- Division of Bone Diseases, University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Bert van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Rene Rizzoli
- Division of Bone Diseases, University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Serge Ferrari
- Division of Bone Diseases, University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Martins A, Monjardino T, Nogueira L, Canhão H, Lucas R. Do bone mineral content and density determine fracture in children? A possible threshold for physical activity. Pediatr Res 2017; 82:396-404. [PMID: 28467405 DOI: 10.1038/pr.2017.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 04/15/2017] [Indexed: 11/09/2022]
Abstract
BackgroundRelations between bone parameters, physical exertion, and childhood fractures are complex. We aimed to estimate the associations between fracture history and bone mineral content (BMC) and areal bone mineral density (aBMD) at 7 years of age, by levels of physical activity, as a proxy for trauma frequency.MethodsWe used data collected from 2,261 children of the Generation XXI birth cohort, assembled in 2005/6 in Porto, Portugal. At the age of 7 years (2012/4), fracture history, time spent per week in active play, and sports practice were reported by parents. Subtotal and lumbar spine (LS) BMC and aBMD were measured using whole-body dual-energy X-ray absorptiometry.ResultsBoys and girls in the highest categories of time spent in sports practice or active play generally had higher BMC and aBMD. Among girls, BMC and aBMD were protective of fracture only in the highest quarter of active play (>660 min/week)-odds ratios (OR; 95% confidence interval (95% CI)) for subtotal BMC=0.27 (0.11-0.67), subtotal aBMD=0.18 (0.06-0.49), and LS aBMD=0.41 (0.22-0.75). For boys in the highest quarter of sports practice (>240 min/week), subtotal and LS BMC were protective of fracture-OR=0.39 (0.16-0.98) and 0.51 (0.27-0.96), respectively.ConclusionIn prepubertal children, BMC and aBMD predicted fracture history only in the highest levels of physical activity.
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Affiliation(s)
- Ana Martins
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Teresa Monjardino
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Luísa Nogueira
- Department of Radiology, School of Health Technology of Porto/Polytechnic Institute of Porto (ESTSP/IPP), Porto, Portugal
| | - Helena Canhão
- EpiDoC, CEDOC, Nova Medical School, NOVA University, Lisbon, Portugal
| | - Raquel Lucas
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
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Lempesis V, Rosengren BE, Nilsson JÅ, Landin L, Johan Tiderius C, Karlsson MK. Time trends in pediatric fracture incidence in Sweden during the period 1950-2006. Acta Orthop 2017; 88:440-445. [PMID: 28562146 PMCID: PMC5499338 DOI: 10.1080/17453674.2017.1334284] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Pediatric fracture incidence may not be stable. We describe recent pediatric fracture epidemiology and etiology and compare this to earlier data. Patients and methods - The city of Malmö (population 271,271 in 2005) in Sweden is served by 1 hospital. Using the hospital diagnosis registry, medical charts, and the radiographic archive, we identified fractures in individuals <16 years that had occurred during 2005 and 2006. We also retrieved previously collected fracture data from between 1950 and 1994, from the hospital's pediatric fracture database. We used official population data to estimate period-specific fracture incidence (the number of fractures per 105 person-years) and also age- and sex-adjusted incidence. Differences are reported as rate ratios (RRs) with 95% confidence intervals. Results - The pediatric fracture incidence during the period 2005-2006 was 1,832 per 105 person-years (2,359 in boys and 1,276 in girls), with an age-adjusted boy-to-girl ratio of 1.8 (1.6-2.1). Compared to the period 1993-1994, age-adjusted rates were unchanged (RR =0.9, 95% CI: 0.8-1.03) in 2005-2006, with lower rates in girls (RR =0.8, 95% CI: 0.7-0.99) but not in boys (RR =1.0, 95% CI: 0.9-1.1). We also found that the previously reported decrease in unadjusted incidence in Malmö from 1976-1979 to 1993-1994 was based on changes in demography, as the age-adjusted incidences were similar in the 2 periods (RR =1.0, 95% CI: 0.9-1.1). Interpretation - In Malmö, pediatric fracture incidence decreased from 1993-1994 to 2005-2006 in girls but not in boys. Changes in demography, and also other factors, influence the recent time trends.
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Sarinho ESC, Melo VMPP. GLUCOCORTICOID-INDUCED BONE DISEASE: MECHANISMS AND IMPORTANCE IN PEDIATRIC PRACTICE. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2017; 35:207-215. [PMID: 28977339 PMCID: PMC5496716 DOI: 10.1590/1984-0462;2017/;35;2;00007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/27/2016] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To describe mechanisms by which glucocorticoids cause osteoporosis, with fracture risk, combining this learning with a possible professional behavior change. DATA SOURCES A systematic search on SciELO, PubMed, Scopus, and Medline databases was carried out for consensus, review articles, including systematic reviews and meta-analysis, which were published in English, between 2000 and 2016. Keywords used on the search were the following: glucocorticoids, fractures, osteoporosis, bone health, vitamin D, children, and adolescents. DATA SYNTHESIS The review was divided into four topics: 1) introduction, with a brief focus on pediatric fractures; 2) osteoporosis in children and adolescents, highlighting it as a silent cause of fractures; 3) glucocorticoids and secondary bone disease, describing deleterious mechanisms of this steroids group on bone structure; 4) molecular effects of glucocorticoids excess on bone, with details about the harmful mechanisms on bone molecular level. CONCLUSIONS Glucocorticoids excess determines early bone disease, favoring the occurrence of fractures. Thus, a child or an adolescent who uses glucocorticoids, especially systemically and chronically, but also repeats cycles at high cumulative doses of the medication, needs care and guidance related to bone health at the onset of treatment. On the other hand, the presence of fractures, even if related to trauma, can be a sign of underlying and unknown bone fragility, which may be secondary to the use of glucocorticoids and/or vitamin D deficiency.
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Huang DF, Lv DK, Zhao QL, Zhang LF. BONE FRAGILITY, FRACTURE RISK AND TRAUMA:A COMPLICATED TRIANGLE IN CHILDREN. ACTA ORTOPEDICA BRASILEIRA 2017. [PMID: 28642660 PMCID: PMC5474422 DOI: 10.1590/1413-785220172502163455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: To analyze whether association between bone fragility and risk of fracture depends on the trauma level. Method: All participants along with their mothers underwent DXA scan and body measurements. The subjects answered a self-report questionnaire about their physical activities and the precipitating causes. The questionnaire results were associated with DXA performed at the baseline visit. Results: A total 374 children with available DXA scan and complete follow-up of 5 years were included in the final analysis. Of the 374 children, 53 (14.2%) had one fracture, and 11 (20.7%) had more than one fracture. Based on the modified Landin classification, the trauma level was determined. Of the 53 (14.2%) children who had one fracture, 39 (73.6%) were classified, namely 19 (48.7%) with mild trauma, 16 (41%) with moderate trauma and four (10.2%) with severe trauma. Trauma level could not be assigned to 14 (26.4%) children due to limited information. Children without fractures had significantly higher values in all bone parameters compared to those with fractures caused by mild trauma. Conclusion: Subjects with mild trauma fractures had an inversely proportional ratio between bone fragility parameters and fracture risk compared with subjects without fractures. Level of Evidence IV, Case Series.
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Affiliation(s)
- De-fa Huang
- Shandong Jining No.1 People's Hospital, China
| | - Deng-kun Lv
- Shandong Jining No.1 People's Hospital, China
| | - Qi-lin Zhao
- Shandong Jining No.1 People's Hospital, China
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Cöster ME, Fritz J, Nilsson JÅ, Karlsson C, Rosengren BE, Dencker M, Karlsson MK. How does a physical activity programme in elementary school affect fracture risk? A prospective controlled intervention study in Malmo, Sweden. BMJ Open 2017; 7:e012513. [PMID: 28235964 PMCID: PMC5337742 DOI: 10.1136/bmjopen-2016-012513] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Recent evidence from the 7-year follow-up of the Pediatric Osteoporosis Prevention (POP) study indicates an inverse correlation between years of participation in a physical activity (PA) intervention and fracture risk in children. However, we could not see a statistically significant reduction in fracture risk, which urged for an extension of the intervention. SETTING The study was conducted in 4 neighbouring elementary schools, where 1 school functioned as intervention school. PARTICIPANTS We included all children who began first grade in these 4 schools between 1998 and 2012. This resulted in 1339 children in the intervention group and 2195 children in the control group, all aged 6-8 years at the state of the study. INTERVENTION We launched an 8-year intervention programme with 40 min of moderate PA per school day, while the controls continued with the Swedish national standard of 60 min of PA per week. PRIMARY OUTCOME MEASURE We used the regional radiographic archive to register objectively verified fractures and we estimated annual fracture incidences and incidence rate ratios (IRRs). RESULTS During the first year after initiation of the intervention, the fracture IRR was 1.65 (1.05 to 2.08) (mean 95% CI). For each year of the study, the fracture incidence rate in the control group compared with the intervention group increased by 15.7% (5.6% to 26.8%) (mean 95% CI). After 8 years, the IRR of fractures was 52% lower in the intervention group than in the control group (IRR 0.48 (0.25 to 0.91) (mean 95% CI))]. CONCLUSIONS Introduction of the school-based intervention programme is associated with a higher fracture risk in the intervention group during the first year followed by a gradual reduction, so that during the eighth year, the fracture risk was lower in the intervention group. TRIAL REGISTRATION NUMBER NCT00633828.
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Affiliation(s)
- Marcus E Cöster
- Department of Orthopedics and Clinical Sciences, Clinical and Molecular Osteoporosis Research Unit, Malmö, Sweden
| | - Jesper Fritz
- Department of Orthopedics and Clinical Sciences, Clinical and Molecular Osteoporosis Research Unit, Malmö, Sweden
| | - Jan-Åke Nilsson
- Department of Orthopedics and Clinical Sciences, Clinical and Molecular Osteoporosis Research Unit, Malmö, Sweden
| | - Caroline Karlsson
- Department of Orthopedics and Clinical Sciences, Clinical and Molecular Osteoporosis Research Unit, Malmö, Sweden
| | - Björn E Rosengren
- Department of Orthopedics and Clinical Sciences, Clinical and Molecular Osteoporosis Research Unit, Malmö, Sweden
| | - Magnus Dencker
- Department of Physiology and Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus K Karlsson
- Department of Orthopedics and Clinical Sciences, Clinical and Molecular Osteoporosis Research Unit, Malmö, Sweden
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Karpiński M, Galicka A, Milewski R, Popko J, Badmaev V, Stohs SJ. Association between Vitamin D Receptor Polymorphism and Serum Vitamin D Levels in Children with Low-Energy Fractures. J Am Coll Nutr 2017; 36:64-71. [PMID: 28067591 DOI: 10.1080/07315724.2016.1218803] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Fractures of bones, especially forearm fractures, are very common in children and their number is increasing. This study was designed to determine the impact of vitamin D serum levels and vitamin D receptor (VDR) polymorphisms on the occurrence of low-energy fractures in children. METHODS The study group consisted of 100 children with clinically relevant bone fractures and a control group consisted of 127 children without fractures. Total vitamin D [25(OH)D3 plus 25(OH)D2] serum concentrations were evaluated in every patient. Genotypes for 4 restriction fragment length polymorphisms of the vitamin D receptor gene (FokI, ApaI, TaqI, and BsmI) were determined by standard polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) techniques. RESULTS Differences in concentrations of vitamin D were observed between the group with bone fractures (median = 12 ng/ml) and the control group (median = 16 ng/ml; p = 0.000044). Higher levels of vitamin D reduced the risk of fracture by 1.06 times (p = 0.0005). No impact of particular VDR polymorphism on the occurrence of low-energy fractures in children was detected. However, there were significant differences in the prevalence of FokI polymorphism genotypes between the fracture and control groups (p = 0.05). Furthermore, the recessive "aa" genotype of ApaI polymorphism and the dominant "TT" genotype of TaqI polymorphism were associated with higher levels of vitamin D (p = 0.005 and p = 0.036, respectively). CONCLUSIONS Vitamin D deficiency is an independent risk factor for fractures in children. ApaI polymorphism recessive "aa" and TaqI polymorphism dominant "TT" genotypes are associated with higher levels of vitamin D in serum.
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Affiliation(s)
- Michal Karpiński
- a Department of Pediatric Orthopedics and Traumatology , Medical University of Bialystok , Białystok , POLAND
| | - Anna Galicka
- b Department of Medical Chemistry , Medical University of Bialystok , Białystok , POLAND
| | - Robert Milewski
- c Department of Statistics and Medical Informatics , Medical University of Bialystok , Białystok , POLAND
| | - Janusz Popko
- a Department of Pediatric Orthopedics and Traumatology , Medical University of Bialystok , Białystok , POLAND
| | | | - Sidney J Stohs
- e School of Pharmacy and Health Professions, Creighton University , Omaha , Nebraska
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Nutritional Aspects of Bone Health and Fracture Healing. J Osteoporos 2017; 2017:4218472. [PMID: 29464131 PMCID: PMC5804294 DOI: 10.1155/2017/4218472] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/25/2017] [Accepted: 11/15/2017] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Fractures are quite common, especially among the elderly. However, they can increase in prevalence in younger ages too if the bone health is not good. This may happen as a result of bad nutrition. METHODS A customized, retrospective review of available literature was performed using the following keywords: bone health, nutrition, and fractures. RESULTS Insufficient intake of certain vitamins, particularly A and D, and other nutrients, such as calcium, may affect bone health or even the time and degree of bone healing in case of fracture. The importance of different nutrients, both dietary and found in food supplements, is discussed concerning bone health and fracture healing. CONCLUSION A healthy diet with adequate amounts of both macro- and micronutrients is essential, for both decreasing fracture risk and enhancing the healing process after fracture.
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Randsborg PH, Røtterud JH. No difference in the level of physical activity between children who have or have never sustained a fracture. Scand J Med Sci Sports 2016; 27:1801-1805. [PMID: 27739115 DOI: 10.1111/sms.12787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 11/30/2022]
Abstract
This study investigates whether children with an acute fracture have a different level of physical activity compared to children who have never sustained a fracture, as measured by the Physical Activity Questionnaire for older children (PAQ-C). The PAQ-C scores of 683 children (295 girls) aged 6-12 years (mean age 9.4 years) who presented to our institution with an acute fracture were compared to the PAQ-C scores of 151 random children (81 girls) aged 6-12 years (mean 9.1 years) in the same area who had never sustained a fracture. Multivariate regression analysis was employed, controlling for age and gender. The mean PAQ-C score of the children who presented to the institution with an acute fracture was 2.85 (95% confidence interval [CI], 2.80-2.91). For the children who had never sustained a fracture, the mean PAQ-C score was 2.78 (95% CI, 2.69-2.87). If there is a true difference in the level of physical activity between children who have or have never sustained a fracture, the PAQ-C questionnaire is not sensitive enough to identify it.
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Affiliation(s)
- P-H Randsborg
- The Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
| | - J H Røtterud
- The Department of Orthopaedic Surgery, Akershus University Hospital, Lørenskog, Norway
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Fritz J, Rosengren BE, Dencker M, Karlsson C, Karlsson MK. A seven-year physical activity intervention for children increased gains in bone mass and muscle strength. Acta Paediatr 2016; 105:1216-24. [PMID: 27096878 DOI: 10.1111/apa.13440] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 01/30/2016] [Accepted: 04/18/2016] [Indexed: 11/30/2022]
Abstract
AIM This study evaluated the musculoskeletal effects of increased physical activity on children, starting at six to nine years of age. METHODS In one school we increased the physical education of 72 girls and 100 boys to 200 minutes per week over seven years. In three other schools, 45 girls and 47 boys continued to receive 60 minutes per week. We measured areal bone mineral density (aBMD) with dual energy X-ray absorptiometry and muscle strength with computerised dynamometer at baseline and after seven years and tibial cortical thickness with peripheral quantitative computed tomography after seven years. RESULTS Girls in the intervention group gained 0.04 g/cm(2) (0.01-0.08) more total spine aBMD (p < 0.05) and 6.2Nm (1.6, 10.7) more knee flexion strength (p < 0.01) than control group girls and had a 0.1 mm (0.0, 0.3) higher tibial cortical thickness at follow-up (p < 0.05). Boys in the intervention group gained 7.3Nm (0.4, 14.2) more knee extension strength (p < 0.05) and 7.4Nm (2.3, 12.4) more knee flexion strength (p < 0.01) than the control group boys, but their aBMD was no higher than the control group. CONCLUSION A seven-year, population-based moderately intense exercise intervention enhanced gains in spine bone mass in girls and knee muscle strength in both genders.
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Affiliation(s)
- Jesper Fritz
- Clinical and Molecular Osteoporosis Research Unit; Department of Orthopedics and Clinical Sciences; Lund University; Skåne University Hospital; Malmö Sweden
| | - Björn E. Rosengren
- Clinical and Molecular Osteoporosis Research Unit; Department of Orthopedics and Clinical Sciences; Lund University; Skåne University Hospital; Malmö Sweden
| | - Magnus Dencker
- Clinical and Molecular Osteoporosis Research Unit; Department of Orthopedics and Clinical Sciences; Lund University; Skåne University Hospital; Malmö Sweden
| | - Caroline Karlsson
- Clinical and Molecular Osteoporosis Research Unit; Department of Orthopedics and Clinical Sciences; Lund University; Skåne University Hospital; Malmö Sweden
| | - Magnus K. Karlsson
- Clinical and Molecular Osteoporosis Research Unit; Department of Orthopedics and Clinical Sciences; Lund University; Skåne University Hospital; Malmö Sweden
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Digby MG, Bishop NJ, Paggiosi MA, Offiah AC. HR-pQCT: a non-invasive 'biopsy' to assess bone structure and strength. Arch Dis Child Educ Pract Ed 2016; 101:268-70. [PMID: 27122599 DOI: 10.1136/archdischild-2015-309455] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/06/2016] [Indexed: 01/01/2023]
Affiliation(s)
- M G Digby
- Sheffield Medical School, University of Sheffield, Sheffield, UK
| | - N J Bishop
- Academic Unit of Child Health, University of Sheffield, Sheffield, UK
| | - M A Paggiosi
- Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - A C Offiah
- Academic Unit of Child Health, University of Sheffield, Sheffield, UK
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Perry BA, Archer KR, Song Y, Ma Y, Green JK, Elefteriou F, Dahir KM. Medication therapy for attention deficit/hyperactivity disorder is associated with lower risk of fracture: a retrospective cohort study. Osteoporos Int 2016; 27:2223-2227. [PMID: 26928186 DOI: 10.1007/s00198-016-3547-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 02/17/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED The impact of pharmacotherapy for attention deficit/hyperactivity disorder on fracture risk has not been well studied. In this retrospective cohort study, medication therapy was associated with lower fracture incidence. Further studies are needed to better characterize the short-term and long-term effects of these medications on bone health and fracture risk. INTRODUCTION Attention deficit/hyperactivity disorder (ADHD) is associated with increased risk of bone fractures. The impact of pharmacotherapy with either stimulant or non-stimulant medications on fracture risk has not been well characterized. We performed a study to compare fracture incidence in ADHD patients treated with stimulant or non-stimulant medications vs. no pharmacotherapy. METHODS In this retrospective cohort study, data were extracted from a large electronic medical record. A total of 10,066 subjects with ADHD, 40 years or younger, were included. We extracted data regarding stimulant and non-stimulant ADHD medications, corticosteroids, fracture data, demographic data, and diabetes history. RESULTS A total of 1015 patients (10 %) sustained fractures. Multivariable Cox proportional hazard analysis indicated that compared to those with two or more prescriptions for an ADHD medication, individuals without documented medication therapy had a significantly increased hazard of fracture (hazard ratio [HR] 3.9, 95 % confidence interval [CI] 2.6-5.9). However, the hazard ratio for stimulant vs. non-stimulant medication (HR 0.92, 95 % CI 0.60-1.4) was not statistically significant. CONCLUSIONS Three times as many patients with no documented ADHD medication prescriptions suffer a fracture compared to patients with a history of two or more prescriptions for an ADHD medication. Treatment and adherence are thus important to prevent fracture in this population.
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Affiliation(s)
- B A Perry
- Department of Medicine, Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University, Nashville, USA
| | - K R Archer
- Department of Orthopaedic Surgery, Vanderbilt University, Nashville, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University, Nashville, USA
| | - Y Song
- Department of Biostatistics, School of Medicine, Vanderbilt University, Nashville, USA
| | - Y Ma
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, Nashville, USA
| | - J K Green
- Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, Nashville, USA
- Department of Pharmacology, Vanderbilt University, Nashville, USA
- Department of Cancer Biology, Vanderbilt University, Nashville, TN, USA
| | - F Elefteriou
- Department of Medicine, Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University, Nashville, USA
- Department of Medicine, Vanderbilt University, Nashville, USA
- Department of Cancer Biology, Vanderbilt University, Nashville, TN, USA
| | - K M Dahir
- Department of Medicine, Division of Diabetes, Endocrinology, and Metabolism, Vanderbilt University, Nashville, USA
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Fracture risk and correlating factors of a pediatric population with attention deficit hyperactivity disorder: a nationwide matched study. J Pediatr Orthop B 2016; 25:369-74. [PMID: 26523534 DOI: 10.1097/bpb.0000000000000243] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to investigate the risk of fracture and the difference between sexes from a nationwide database of fracture risk among children aged 4-17 years with or without attention deficit hyperactivity disorder (ADHD, ICD-9-CD codes 314). The Longitudinal Health Insurance Database (LHID 2000) was used to analyze fracture characteristics of children from the National Health Insurance that covered 96.1% of the Taiwanese population (N=21.4 million). A total of 7200 ADHD children aged between 4 and 17 years whose diagnosis had been confirmed in at least three outpatient clinics between 1 January 2000 and 31 December 2009 were included, and a cohort of 36 000 children without ADHD matched for age, sex, and urbanization was recruited for analysis. The incidence rate of fractures in ADHD children was 21.0 (95% confidence interval=19.4-22.7) per 1000 person-years, significantly (P<0.001) higher than 15.0 (95% confidence interval=14.4-15.6) in non-ADHDs. After adjusting by age, sex, urbanization level, and geographic region, the statistically significant (P<0.001) hazard ratios (HR) of fracture for ADHD children compared with non-ADHD children included 1.62 in girls and 1.38 in boys, 1.53 in the skull, neck, and trunk (ICD-9-CM 800-809), 1.28 in the upper extremity (ICD-9-CM 810-819), and 1.84 in the lower extremity (ICD-9-CM 820-829). The HR also (P<0.001) increased significantly in all age groups, including 1.35 in 4-6, 1.37 in 7-9, and 1.54 in 10-17 years. ADHD should be listed among risk factors of children's fractures in each sex, all age groups, and all body areas that the parents, teachers, caregivers of ADHD children, and pediatric orthopedists should be aware of. Besides, ADHD girls were more affected than ADHD boys, especially after 10 years of age, whereas the adjusted HR was the highest in the lower extremities. Nationwide analysis matched for age and sex showed that ADHD should be considered the risk factor of children's fracture, especially for girls older than 10 years of age.
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Jerrhag D, Englund M, Petersson I, Lempesis V, Landin L, Karlsson MK, Rosengren BE. Increasing wrist fracture rates in children may have major implications for future adult fracture burden. Acta Orthop 2016; 87:296-300. [PMID: 26905618 PMCID: PMC4900094 DOI: 10.3109/17453674.2016.1152855] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Background and purpose - Childhood fractures are associated with lower peak bone mass (a determinant of osteoporosis in old age) and higher adult fracture risk. By examining time trends in childhood fracture epidemiology, it may be possible to estimate the vector of fragility fracture risk in the future. Patients and methods - By using official inpatient and outpatient data from the county of Skåne in Sweden, 1999-2010, we ascertained distal forearm fractures in children aged ≤ 16 years and estimated overall and age- and sex-specific rates and time trends (over 2.8 million patient years) and compared the results to earlier estimations in the same region from 1950 onwards. Results - During the period 1999-2010, the distal forearm fracture rate was 634 per 10(5) patient years (750 in boys and 512 in girls). This was 50% higher than in the 1950s with a different age-rate distribution (p < 0.001) that was most evident during puberty. Also, within the period 1999-2010, there were increasing fracture rates per 10(5) and year (boys +2.0% (95% CI: 1.5-2.6), girls +2.4% (95% CI: 1.7-3.1)). Interpretation - The distal forearm fracture rate in children is currently 50% higher than in the 1950s, and it still appears to be increasing. If this higher fracture risk follows the children into old age, numbers of fragility fractures may increase sharply-as an upturn in life expectancy has also been predicted. The origin of the increase remains unknown, but it may be associated with a more sedentary lifestyle or with changes in risk behavior.
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Affiliation(s)
- Daniel Jerrhag
- Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopedics Malmö, Skåne University Hospital, Lund University,,Correspondence:
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden,,Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA
| | - Ingmar Petersson
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden,
| | - Vasileios Lempesis
- Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopedics Malmö, Skåne University Hospital, Lund University,
| | - Lennart Landin
- Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopedics Malmö, Skåne University Hospital, Lund University,
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopedics Malmö, Skåne University Hospital, Lund University,
| | - Bjorn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Departments of Clinical Sciences and Orthopedics Malmö, Skåne University Hospital, Lund University,
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Moon RJ, Harvey NC, Curtis EM, de Vries F, van Staa T, Cooper C. Ethnic and geographic variations in the epidemiology of childhood fractures in the United Kingdom. Bone 2016; 85:9-14. [PMID: 26802259 PMCID: PMC4841386 DOI: 10.1016/j.bone.2016.01.015] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 01/12/2016] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Fractures are common in childhood, and there is considerable variation in the reported incidence across European countries, but few data relating to ethnic and geographic differences within a single country. We therefore aimed to determine the incidence of childhood fractures in the United Kingdom (UK), and to describe age-, ethnicity- and region- specific variations. METHODS The Clinical Practice Research Datalink (CPRD) contains anonymised electronic health records for approximately 7% of the UK population. The occurrence of a fracture between 1988 and 2012 was determined from the CPRD for all individuals <18years of age, and used to calculate fracture incidence rates for age, sex and ethnicity. Regional fracture incidence rates were also calculated based on general practitioner location within 14 Strategic Health Authorities (SHA) within the UK. RESULTS The overall fracture incidence rate was 137 per 10,000 person-years (py). This was higher in boys (169 per 10,000 py) than girls (103 per 10,000 py) and white children (150 per 10,000 py) compared to those of black (64 per 10,000 py) and South Asian (81 per 10,000 py) ethnicity. Marked geographic variation in incidence was observed. The highest fracture rates were observed in Wales, where boys and girls had 1.82 and 1.97 times greater incidence, respectively, than those residing in Greater London. CONCLUSION In the period 1988-2012, there was marked geographic and ethnic variation in childhood fracture incidence across the UK. These findings also implicate lifestyle and socio-economic differences associated with location and ethnicity, and are relevant to policy makers in the UK and internationally.
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Affiliation(s)
- Rebecca J Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK; Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK; NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK, SO16 6YD, UK
| | - Elizabeth M Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Frank de Vries
- Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tjeerd van Staa
- Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, 1.003 Vaughan House, Portsmouth, Road, M13 9PL, UK; Department of Pharmacoepidemiology & Clinical Pharmacology, University of Utrecht, Utrecht, the Netherlands, 3508, TB
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK; NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK, SO16 6YD, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, OX3 7LD, UK.
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Heaney RP. Achieving the protection of high peak bone mass. Osteoporos Int 2016; 27:1279-1280. [PMID: 26733372 DOI: 10.1007/s00198-015-3467-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 12/16/2015] [Indexed: 11/26/2022]
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Avila ML, Pullenayegum E, Williams S, Shammas A, Stimec J, Sochett E, Marr K, Brandão LR. Timing of low bone mineral density and predictors of bone mineral density trajectory in children on long-term warfarin: a longitudinal study. Osteoporos Int 2016; 27:1547-1557. [PMID: 26572757 DOI: 10.1007/s00198-015-3411-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 11/05/2015] [Indexed: 01/06/2023]
Abstract
UNLABELLED We studied bone mineral density (BMD) of children exposed to long-term warfarin. BMD Z-scores ≤ -2.0 were estimated to occur in less than one fifth of the patients after 10 years of warfarin exposure, and BMI and growth hormone deficiency predicted BMD changes over time. These predictors can help identify high-risk patients. INTRODUCTION Children with chronic diseases are at increased risk of developing thrombosis, which may require long-term warfarin therapy. Warfarin could further jeopardize the bone health of a population already at risk for bone fragility. Our objective was to investigate the occurrence and timing of low bone mineral density (BMD) and the predictors that influence BMD trajectory in children receiving warfarin for >1 year. METHODS We analyzed the results of an institutional protocol that includes dual-energy X-ray absorptiometry, with or without spinal X-rays and laboratory biomarkers, as required. RESULTS Low BMD (age, sex, race, and height-for-age-Z-score adjusted BMD Z-score ≤ -2.0) was detected in 13 % (9/70) of the patients at some point during their follow-up; these patients were more likely to have complex underlying medical conditions and low body mass index (BMI) percentile. BMD Z-scores remained within normal range in 87 % of children. Survival analysis showed that the estimated 10-year abnormal BMD-free rate for the entire group was 81 % (95 % confidence interval [CI] 69 to 93 %). Trajectory analysis revealed that BMI percentiles at baseline and growth hormone deficiency (GHD) were associated with lower BMD Z-scores at the first assessment, whereas baseline BMI percentile was the only predictor of BMD Z-score over time. CONCLUSIONS Our findings identified BMI and GHD as risk factors influencing BMD in children exposed to long-term warfarin, creating an opportunity for early detection and intervention in these patients.
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Affiliation(s)
- M L Avila
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, M5G-1X8, ON, Canada
| | - E Pullenayegum
- Child Health Evaluative Sciences, The Hospital for Sick Children, University of Toronto, Toronto, M5G-1X8, ON, Canada
| | - S Williams
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, M5G-1X8, ON, Canada
| | - A Shammas
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, M5G-1X8, ON, Canada
| | - J Stimec
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, M5G-1X8, ON, Canada
| | - E Sochett
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, M5G-1X8, ON, Canada
| | - K Marr
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, M5G-1X8, ON, Canada
| | - L R Brandão
- Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, M5G-1X8, ON, Canada.
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