Fracture rates in urban South African children of different ethnic origins: The Birth to Twenty Cohort

Thandrayen, Kebashni; Norris, Shane A.; Pettifor, John M.

doi:10.1007/s00198-008-0627-x

Cited by 54 publications

(36 citation statements)

References 21 publications

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“…A study of English children (3, 4) suggested a higher fracture rate in whites compared with non-whites, although statistical significance was not established. A study of South African children found the rate of fractures for white children to be almost twice that of children of African ancestry (5, 6). The purpose of this prospective, multi-center study was to examine race/ethnicity as a risk factor for fracture in a large, diverse cohort of children and adolescents from different regions across the United States (U.S.).…”

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confidence: 99%

Racial Disparity in Fracture Risk between White and Nonwhite Children in the United States

Wren

Shepherd

Kalkwarf

et al. 2012

The Journal of Pediatrics

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Objectives To examine risk factors for fracture in a racially diverse cohort of healthy children in the United States. Study design A total of 1,470 healthy children, ages 6–17 years, underwent yearly evaluations of height, weight, body mass index, skeletal age, sexual maturation, calcium intake, physical activity levels, and dual-energy x-ray absorptiometry (DXA) bone and fat measurements for up to 6 years. Fracture information was obtained at each annual visit, and risk factors for fracture were examined using the time-dependent Cox proportional hazards model. Results The overall fracture incidence was 0.034 fractures per person-year with 212 children reporting a total of 257 fractures. Being white (hazard ratio [HR]=2.1), male (HR=1.8), and having skeletal age of 10–14 years (HR=2.2) were the strongest risk factors for fracture (all P≤0.001). Increased sports participation (HR=1.4), lower body fat percentage (HR=0.97), and previous fracture in white females (HR=2.1) were also significant risk factors (all P≤0.04). Overall, fracture risk decreased with higher DXA Z-scores, except in white males who had increased fracture risk with higher DXA Z-scores (HR=1.7, P<0.001). Conclusions Boys and girls of European descent had double the fracture risk of children from other backgrounds, suggesting that the genetic predisposition to fractures seen in elderly adults also manifests in children.

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Racial Disparity in Fracture Risk between White and Nonwhite Children in the United States

Wren

Shepherd

Kalkwarf

et al. 2012

The Journal of Pediatrics

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“…30 Although African American children have a relatively increased BMD in comparison with white children and studies of a South African cohort show higher fracture rates in white children, other studies show a higher incidence of femur fracture and fracture-related hospitalizations in African American children. [31][32][33][34][35] Incidence of childhood forearm fracture, by race, has not been reported.…”

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Bone Mineral Density and Vitamin D Status Among African American Children With Forearm Fractures

Ryan¹,

Teach²,

Singer

et al. 2012

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Forearm fractures are unique injuries which are associated with lower bone mineral density in adults and white children. The relationships among bone mineral density, 25-hydroxyvitamin D status, and risk for forearm fracture have not been investigated in African American children. WHAT THIS STUDY ADDS:Our data support an association between both lower bone mineral density and vitamin D deficiency and increased odds of forearm fracture in African American children. Promotion of bone health is indicated in this population.abstract OBJECTIVE: To determine whether African American children with forearm fractures have decreased bone mineral density and an increased prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D level #20 ng/mL) compared with fracture-free control patients. METHODS:This case-control study in African American children, aged 5 to 9 years, included case patients with forearm fracture and control patients without fracture. Evaluation included measurement of bone mineral density and serum 25-hydroxyvitamin D level. Univariable and multivariable analyses were used to test for associations between fracture status and 2 measures of bone health (bone mineral density and 25-hydroxyvitamin D level) while controlling for other potential confounders. RESULTS:The final sample included 76 case and 74 control patients. There were no significant differences between case and control patients in age, gender, parental education level, enrollment season, outdoor play time, height, or mean dietary calcium nutrient density. Cases were more likely than control patients to be overweight (49.3% vs 31.4%, P = .03). Compared with control patients, case patients had lower whole body z scores for bone mineral density (0.62 6 0.96 vs 0.98 6 1.09; adjusted odds ratio 0.38 [0.20-0.72]) and were more likely to be vitamin D deficient (47.1% vs 40.8%; adjusted odds ratio 3.46 [1.09-10.94]). CONCLUSIONS:These data support an association of lower bone mineral density and vitamin D deficiency with increased odds of forearm fracture among African American children. Because suboptimal childhood bone health also negatively impacts adult bone health, interventions to increase bone mineral density and correct vitamin D deficiency are indicated in this population to provide short-term and long-term benefits. Pediatrics 2012;130:e553-e560

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“…Fractures in this age group are rare. The yearly incidence of fractures ranges from 0.14% to 1% from birth to 11 months and from 0.06% to 3% from 1 to 2 years (48)(49)(50). In the study by Leventhal et al ( 49 ), fractures in children younger than 36 months were attributed to abuse in 12% and to metabolic abnormalities such as rickets in 0.12%-a 100-fold difference.…”

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confidence: 98%

Rachitic Changes, Demineralization, and Fracture Risk in Healthy Infants and Toddlers with Vitamin D Deficiency

Peréz-Rosselló¹,

Feldman²,

Kleinman³

et al. 2012

Radiology

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Purpose:To examine radiographic fi ndings in children with vitamin D defi ciency in comparison with biochemical marker levels and prevalence of fractures. Materials and Methods:The parents or guardians of all participants provided written informed consent at the time of enrollment. The institutional review board approved the protocol, and HIPAA guidelines were followed. From a prospective sample of children seen for routine clinical care, 40 children with vitamin D defi ciency (25-hydroxyvitamin D [25-OHD] level, Յ 20 ng/mL) were identifi ed, and high-detail computed radiographs of the wrists and knees were obtained. The children ranged in age from 8 to 24 months. Radiographs were scored by three readers with use of the 10-point Thacher score for rachitic changes and a fi ve-point scale for demineralization. Serum calcium, phosphorus, alkaline phosphatase, and parathyroid hormone levels were determined. Fracture history was obtained for 35 of the 40 patients (88%). Results:All readers identifi ed rachitic changes at both readings in two patients (5%) and demineralization in two patients (5%). Interrater agreement was 65% for rachitic changes ( k = 0.33) and 70% for demineralization ( k = 0.37). When the majority of the raters determined that rachitic changes were absent at both readings, alkaline phosphatase levels were lower than those with other assessments (median, 267 vs 515 U/L [4.4589 vs 8.6005 m kat/L ]; P = .01). When most raters determined that demineralization was present at both readings, serum 25-OHD levels were lower than those at other assessments (median, 9.0 vs 17.5 ng/mL [22.464 vs 43.68 nmol/L]; P = .02 ). No fractures were reported or identifi ed radiographically. Conclusion:In infants and toddlers with vitamin D defi ciency, rachitic changes and defi nite demineralization are uncommon and fracture risk is low.q RSNA, 2011

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Fracture rates in urban South African children of different ethnic origins: The Birth to Twenty Cohort

Cited by 54 publications

References 21 publications

Racial Disparity in Fracture Risk between White and Nonwhite Children in the United States

Racial Disparity in Fracture Risk between White and Nonwhite Children in the United States

Bone Mineral Density and Vitamin D Status Among African American Children With Forearm Fractures

Rachitic Changes, Demineralization, and Fracture Risk in Healthy Infants and Toddlers with Vitamin D Deficiency

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