Epidemiology of fractures of the distal end of the radius in children as associated with growth.

Bailey, D. A.; Wedge, John H.; McCulloch, Robert G.; Martin, A. D.; Bernhardson, S C

doi:10.2106/00004623-198971080-00016

Cited by 315 publications

(246 citation statements)

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Taes

Lapauw

Vanbillemont

et al. 2010

Journal of Bone and Mineral Research

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Low areal bone mass is a risk factor for fractures in men. Limited data are available on fractures and bone geometry in men, and the relation with sex steroids is incompletely understood. We investigated prevalent fractures in relation to peak bone mass, bone geometry, and sex steroids in healthy young men. Healthy male siblings (n ¼ 677) at the age of peak bone mass (25 to 45 years) were recruited in a cross-sectional population-based study. Trabecular and cortical bone parameters of the radius and cortical bone parameters of the tibia were assessed using peripheral quantitative computed tomography (pQCT). Areal bone mineral density (aBMD) was determined using dual-energy X-ray absorptiometry (DXA). Sex steroids were determined using immunoassays, and fracture prevalence was assessed using questionnaires. Fractures in young men were associated with a longer limb length, shorter trunk, lower trabecular BMD, smaller cortical bone area, and smaller cortical thickness ( p < .005) but not with bone-size-adjusted volumetic BMD (vBMD). With decreasing cortical thickness [odds ratio (OR) 1.4/SD, p .001] and decreasing cortical area (OR 1.5/SD, p .001), fracture odds ratios increased. No association between sex steroid concentrations and prevalent fractures was observed. Childhood fractures ( 15 years) were associated with a thinner bone cortex (À5%, p .005) and smaller periosteal size (À3%, p .005). Fractures occurring later than 15 years of age were associated with a thinner bone cortex (À3%, p .05) and larger endosteal circumference (þ3%, p .05) without differences in periosteal bone size. In conclusion, prevalent fractures in healthy young men are associated with unfavorable bone geometry and not with cortical vBMD when adjusting for bone size. Moreover, the data suggest different mechanisms of childhood fractures and fractures during adult life. ß 2010 American Society for Bone and Mineral Research. KEY WORDS: pQCT; PEAK BONE MASS; OSTEOPOROSIS; MEN; BONE GEOMETRY; FRACTURE IntroductionB one mass at any stage in adult life is determined by the growth and mineralization of the skeleton during the first two decades of life leading to the peak bone mass (PBM) and by subsequent net changes in bone mass, usually bone loss, starting in the middle of the third decade. (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) 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...

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Section: Discussionmentioning

confidence: 99%

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

Taes

Lapauw

Vanbillemont

et al. 2010

Journal of Bone and Mineral Research

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“…Therefore, when disruptive forces are applied to an extremity, failure may occur through the growth plate. The susceptibility of the growth plate to injury appears to be especially pronounced during periods of rapid growth [5][6][7][8][9][10][11][12][13][14][15]. Research pertaining to the development of physeal cartilage in animals shows a decrease in physeal strength during pubescence [6].…”

Section: Susceptibility To Growth Plate Injurymentioning

confidence: 99%

“…In addition, bone mineralization may lag behind bone linear growth during the pubescent growth spurt, thus rendering the bone temporarily more porous and more subject to injury [11,12]. Studies of the incidence of physeal injuries in humans indicate an increased occurrence of fractures during pubescence [11][12][13][14][15].…”

Section: Susceptibility To Growth Plate Injurymentioning

confidence: 99%

Epidemiology of Children’s Individual Sports Injuries

Caine

Maffulli²

2005

Medicine and Sport Science

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“…(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.…”

Section: Introductionmentioning

confidence: 99%

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

Wang

Iuliano-Burns

et al. 2010

Journal of Bone and Mineral Research

110

100

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Fractures of the distal radius in children have a similar incidence to that found in postmenopausal women but occur more commonly in boys than in girls. Fractures of the distal tibia are uncommon in children and show no sex specificity. About 90% of lengthening of the radius but only 30% of lengthening of the tibia during puberty occur at the distal growth plate. We speculated that more rapid modeling at the distal radial metaphysis results in a greater dissociation between growth and mineral accrual than observed at the distal tibia. We measured the macro-and microarchitecture of the distal radial and tibial metaphysis using high-resolution peripheral quantitative computed tomography in a cross-sectional study of 69 healthy boys and 60 healthy girls aged from 5 to 18 years. Bone diameters were larger but total volumetric bone mineral density (vBMD) was lower at the distal radius (not at the distal tibia) by 20% in boys and by 15% in girls at Tanner stage III than in children of the same sex at Tanner stage I (both p < .05). In boys at Tanner stage III, total vBMD was lower because the larger radial total cross-sectional area (CSA) had a thinner cortex with lower vBMD than in boys at Tanner stage I. In girls at Tanner stage III, the larger total radial CSA was not associated with a difference in cortical thickness or cortical vBMD relative to girls in Tanner stage I. Cortical thickness and density at both sites in both sexes after Tanner stage III were greater than in younger children. Trabecular bone volume fraction (BV/TV) was higher in boys than in girls at both sites and more so after puberty because trabeculae were thicker in more mature boys but not in girls. There was no sex-or age-related differences in trabecular number at either site. We infer that longitudinal growth outpaces mineral accrual in both sexes at the distal radius, where bone grows rapidly. The dissociation produces transitory low cortical thickness and vBMD in boys but not in girls. These structural features in part may account for the site and sex specificity of metaphyseal fractures during growth. ß

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Epidemiology of fractures of the distal end of the radius in children as associated with growth.

Cited by 315 publications

References 0 publications

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

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

Epidemiology of Children’s Individual Sports Injuries

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

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