Bone Fragility Contributes to the Risk of Fracture in Children, Even After Moderate and Severe Trauma

Abstract

We prospectively examined whether the relationship between skeletal fragility and fracture risk in children 9.9 ± 0.3 (SD) yr is affected by trauma level. Bone size relative to body size and humeral vBMD showed similar inverse relationships with fracture risk, irrespective of whether fractures followed slight or moderate/severe trauma.Introduction: Fracture risk in childhood is related to underlying skeletal fragility. However, whether this relationship is confined to low-trauma fractures or whether skeletal fragility also contributes to the risk of fracture caused by higher levels of trauma is currently unknown. Materials and Methods: Total body DXA scan results obtained at 9.9 yr of age were linked to reported fractures over the following 2 yr in children from the Avon Longitudinal Study of Parents and Children. DXA scan results that were subsequently derived included total body less head (TBLH) bone size relative to body size (calculated from TBLH area adjusted for height and weight) and humeral volumetric BMD (vBMD; derived from subregional analysis at this site). Trauma level was assigned using the Landin classification based on a questionnaire asking about precipitating causes. Results: Of the 6204 children with available data, 549 (8.9%) reported at least one fracture over the follow-up period, and trauma level was assigned in 280 as follows: slight trauma, 56.1%; moderate trauma, 41.0%; severe trauma, 2.9%. Compared with children without fractures, after adjustment for age, sex, socioeconomic status, and ethnicity, children with fractures from both slight and moderate/severe trauma had a reduced bone size relative to body size (1133 cm 2 in nonfractured children versus 1112 cm 2 for slight trauma fractures, p < 0.001; 1112 cm 2 for moderate/severe trauma fractures, p ‫ס‬ 0.001) and reduced humeral vBMD (0.494 g/cm 3 in nonfractured children versus 0.484 g/cm 3 for slight trauma fractures, p ‫ס‬ 0.036; and 0.482g/cm 3 for moderate/ severe trauma fractures, p ‫ס‬ 0.016). Conclusions: Skeletal fragility contributes to fracture risk in children, not only in fractures caused by slight trauma but also in those that result from moderate or severe trauma.

Fracture Burden and Risk Factors in Childhood CKD

“…However, a prior population-based study demonstrated that skeletal fragility contributed to fracture risk in children, regardless of trauma severity. 41 Since time between visits was up to 1-2 years, censoring at the midpoint of this interval may have created some misclassification of time and consequent imprecision in the observed incidence rates. This, along with the fact that fracture events were not adjudicated by radiology reports, likely biased the results to the null.…”

Prevalent fractures are related to cortical bone geometry in young healthy men at age of peak bone mass

“…(2,3) In both young and older subjects, low areal bone mineral density (aBMD) has been associated with increased fracture prevalence, although most evidence has been obtained in women (4,5) or elderly men, (6) and only limited data are available in boys or young men. (7)(8)(9) osteoporosis, with a similar phenotype in their adult sons, providing evidence for a deficient acquisition of PBM in these men. (11,12) These studies suggested a deficient estrogen exposure as a contributing pathophysiologic mechanism.…”

“…(2,3) In both young and older subjects, low areal bone mineral density (aBMD) has been associated with increased fracture prevalence, although most evidence has been obtained in women (4,5) or elderly men, (6) and only limited data are available in boys or young men. (7)(8)(9) An important limitation of dual-energy X-ray absorptiometry (DXA) is that it measures projected aBMD and not volumetric BMD (vBMD). In determining PBM and future facture risk, this has important clinical implications because bone strength depends not only on the amount of bone tissue but also on the diameter, shape, and volumetric bone density, as well as the distribution of cortical and trabecular bone.…”

Deficits in distal radius bone strength, density and microstructure are associated with forearm fractures in girls: an HR-pQCT study

“…We excluded individuals with previous wrist fractures on the contralateral limb or bilateral wrist fractures (n=15). We categorized trauma degree as low, moderate, or high energy based on a modified version of Landin's classification adapted from Clark et al [18] (Table 1). Of the 543 eligible participants with recent fracture (cases), 267 declined participation and 105 consented to participate but did not schedule a measurement appointment.…”

“…CIHR Author Manuscript CIHR Author Manuscript Table 1 Trauma degree classification (modified from Clark et al [18] and Farr et al [15])…”