Epidemiology of Childhood Fractures in Britain: A Study Using the General Practice Research Database

Abstract

A population-based British cohort study, including ϳ6% of the population, was used to derive age-and sex-specific incidence rates of fractures during childhood. Fractures were more common among boys than girls, with peak incidences at 14 and 11 years of age, respectively. At childhood peak, incidence rates were only surpassed later in life at 85 years of age among women and never among men. Introduction:Fractures account for 25% of accidents and injuries in childhood; however, the descriptive epidemiology of childhood fractures remains uncertain. Materials and Methods: Age-and sex-specific incidence rates for fractures at various skeletal sites were derived from the General Practice Research Database (a population-based British cohort containing computerized medical records of ϳ7,000,000 residents) between 1988 and 1998. Results: A total of 52,624 boys and 31,505 girls sustained one or more fractures over the follow-up period, for a rate of 133.1/10,000 person-years. Fractures were more common in boys (161.6/10,000 person-years) than girls (102.9/ 10,000 person-years). The most common fracture in both sexes was that of the radius/ulna (30%). Fracture incidence was greater among boys than girls at all ages, with the peak incidence at 14 years of age among boys and 11 years of age among girls. Marked geographic variation was observed in standardized fracture incidence, with significantly (p Ͻ 0.01) higher rates observed in Northern Ireland, Wales, and Scotland compared with southeast England. Conclusions: Fractures are a common problem in childhood, with around one-third of boys and girls sustaining at least one fracture before 17 years of age. Rates are higher among boys than girls, and male incidence rates peak later than those among females. At their childhood peak, the incidence of fractures (boys, 3%; girls, 1.5%) is only surpassed at 85 years of age among women and never among men. The most common site affected in both genders is the radius/ulna. Studies to clarify the pathogenesis of these fractures, emphasizing bone fragility, are now required.

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

“…Under-and overreporting can occur owing to poor recall. (44) However, our fracture incidence corresponds to published data, (2) and the accuracy for self-report of fractures was found to be good in postmenopausal women for forearm or hip fractures. (45) Moreover, imprecise data would be expected to weaken the observed associations and in general underestimate associations.…”

“…This observation is in line with literature data because the peak incidence of fractures in girls occurs between 11 and 12 years of age and in boys between 13 and 14 years of age. (2,3,(23)(24)(25) Underlying this observation is a transient increase in bone fragility and cortical porosity leading to a deficit in bone mass relative to longitudinal growth. (26,27) In this regard, the peak height velocity in both boys and girls precedes the time of peak increase in bone mineral content by 1 year.…”

“…(1) Although fracture risk in old age is lower in men than in women, fracture risk is higher in boys and young men than in girls or young women. (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.…”

Observer agreement in pediatric semiquantitative vertebral fracture diagnosis

“…In contrast, the study of pediatric vertebral fracture is in its infancy, in part because these fractures are much less common in the general pediatric population than in adults, in part because of the lack of an accepted technique for diagnosis [10,11]. An important impetus to adult vertebral fracture research was the development of vertebral morphometry techniques that were subsequently shown to be clinically meaningful [12].…”

Rapid growth produces transient cortical weakness: A risk factor for metaphyseal fractures during puberty

“…(1)(2)(3) By contrast, the incidence of distal tibia fracture is low in children and does not differ by sex. (1) Boys are more likely participate in risk-taking activities than girls.…”