Bone fracture in physically disabled children attending schools for handicapped children in Japan

Abstract

Objective Very few epidemiologic studies on bone fracture have been conducted in schools for handicapped children (Yogo schools). The aim of this study was to clarify the frequency and risk factors of bone fracture in physically disabled children in Japan. Methods We used a cross-sectional design to examine 525 physically disabled children in 38 Yogo schools in the Hokuriku-Koshinetsu District of Japan. The questionnaire surveyed information on participant sex, age, level of physical disability, and bone fracture history. Information on fractures was obtained, including number of fractures over participant lifetime, age when fractures occurred, location, and cause. One-year-period prevalence and lifetime prevalence were defined as the proportion of subjects with incident fractures in the previous year and with a history of fracture, respectively. Results Participant ages ranged from 6 to 15 years, and 66.3% had cerebral palsy (CP). The 1-year-period prevalence was 3.6% and lifetime fracture prevalence was 9.7%. The 1-year-period prevalence in the age groups of 6-9, 10-12, and 13-15 years was 2/184 (1.1%), 5/171 (2.9%), and 12/164 (7.3%), respectively (P for trend = 0.0031). There were no differences in period prevalence between sexes, and this was not associated with presence of CP. Multiple logistic regression analysis showed that age and presence of one joint contracture in the lower limbs or hip were independently associated with occurrence of bone fracture over participant lifetime. Conclusions Physically disabled children are at high risk of bone fracture, and further risk factors should be determined.

Evaluation of risk factors associated with fragility fractures and recommendations to optimise bone health in children with long-term neurological condition

“…This finding is close to the rate of 4% found in a systematic review of five studies on children with cerebral palsy[ 3 ] and 3.6% found in schools for physically disabled children, including those with cerebral palsy, traumatic brain injury, encephalitis, myopathy and chromosomal anomalies, in Japan. [ 5 ] In our study, the risk factors for poor bone health included high GMFCS level, lack of regular weight-bearing exercises, being underweight, feeding difficulty, and use of anticonvulsant and steroid. The study also showed that only a minority of children had regular calcium and vitamin D monitoring and supplementation.…”

Anorexia and supracondylar fracture of the femur following surgery for bilateral lower limb joint contracture in a case of severe cerebral palsy with mental retardation: a case report

“…The incidence of fractures with CP is reported at 15–37% 2 , 4 , 7 , 8 ) . Such fractures occur in the lower limb, especially the femurs 9 , 10 ) , and are associated with low BMD 3 ) . Henderson et al.…”

Fifteen-minute consultation: Fractures in non-ambulant children with cerebral palsy

“…1 Fragility fracture prevalence varies between 3% and 12% in children in children with predominantly Level V Gross Motor Function Classification (GMFCS; see box 1). [2][3][4] Fractures can recur; the mean age to first fracture was 10 years in one study. 2 These fractures are generally occasioned by lack of a clear history of trauma, as they can occur during normal care activities.…”