Leptin Elevation as a Risk Factor for Slipped Capital Femoral Epiphysis Independent of Obesity Status

Halverson, Schuyler; Warhoover, Tracy; Mencio, Gregory A.; Lovejoy, Steven A.; Martus, Jeffrey E.; Schoenecker, Jonathan G.

doi:10.2106/jbjs.16.00718

Cited by 36 publications

(28 citation statements)

References 84 publications

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“…The inconsistency between rising obesity rates in children, on the one hand, and stable rates for SCFE, on the other, together with the elevated risk of developing obesity in later life found in this study indicates that not only obesity per se but other factors associated with obesity may play a role in the etiology of SCFE. Halverson et al ( 2017 ) reported elevated serum leptin levels in patients with SCFE, regardless of their BMI, suggesting a shared risk factor for obesity and SCFE. Leptin is a cytokine-like hormone with proinflammatory properties known to be associated with autoimmune disorders, infections, and endocrine and metabolic diseases (Procaccini et al 2015 ).…”

Section: Discussionmentioning

confidence: 99%

Fate of patients with slipped capital femoral epiphysis (SCFE) in later life: risk of obesity, hypothyroidism, and death in 2,564 patients with SCFE compared with 25,638 controls

Hailer

2020

Acta Orthopaedica

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Background and purpose — Associations between obesity and slipped capital femoral epiphysis (SCFE) during adolescence are described; however, few studies report on the lifetime risk of obesity in patients with SCFE. In addition, with the obesity epidemic in children and adolescents, an increasing incidence of SCFE might be expected. An association of SCFE with hypothyroidism seems ambiguous, and the association between SCFE and depression and all-cause mortality has not yet been evaluated. This study investigates the associations of SCFE with obesity, hypothyroidism, depression, and mortality, and putative changes in the yearly incidence of SCFE. Patients and methods — 2,564 patients diagnosed with SCFE at age 5–16 diagnosed between 1964 and 2011 were identified in the Swedish Patient Register. These were matched for age, sex, and residency with unexposed control individuals. Cox regression models were fitted to estimate the risk of obesity, hypothyroidism, depression, and death, in exposed compared with unexposed individuals. Results — The risk of obesity (HR 9, 95% CI 7–11) and hypothyroidism (HR 3, CI 2–4) was higher in SCFE patients compared with controls. There was no increase in the risk of developing depression (HR 1, CI 1–1.3) in SCFE patients. In contrast, all-cause mortality was higher in SCFE patients than in controls (HR 2, CI 1–2). The incidence of SCFE did not increase over the past decades. Interpretation — Patients with SCFE have a higher lifetime risk of obesity and hypothyroidism and a higher risk of all-cause mortality compared with individuals without SCFE. These findings highlight the lifetime comorbidity burden of patients who develop SCFE in childhood, and increased surveillance of patients with a history of SCFE may be warranted. The incidence of SCFE did not increase over the last decades despite increasing obesity rates.

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Section: Discussionmentioning

confidence: 99%

Fate of patients with slipped capital femoral epiphysis (SCFE) in later life: risk of obesity, hypothyroidism, and death in 2,564 patients with SCFE compared with 25,638 controls

Hailer

2020

Acta Orthopaedica

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“…Since then, there have been other studies showing similar results [57, 58] and that the severity of SCFE increases as BMI increases [59], while the incidence of bilaterally SCFE also increases [60]. There are conflicting reports if SCFE is related to vitamin D intake [61], and yet, a new study shows an association between elevated serum leptin levels and SCFE, regardless of BMI [62]. This further demonstrates that SCFE is multifactorial disease that may not be strictly dependent on the altered biomechanics hypothesis.…”

Section: Main Textmentioning

confidence: 88%

The role of PPARγ in childhood obesity-induced fractures

McCann

Ratneswaran

2019

Genes Nutr

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Globally, obesity is on the rise with ~ 30% of the world’s population now obese, and childhood obesity is following similar trends. Childhood obesity has been associated with numerous chronic conditions, including musculoskeletal disorders. This review highlights the effects of childhood adiposity on bone density by way of analyzing clinical studies and further describing two severe skeletal conditions, slipped capital femoral epiphysis and Blount’s disease. The latter half of this review discusses bone remodeling and cell types that mediate bone growth and strength, including key growth factors and transcription factors that help orchestrate this complex pathology. In particular, the transcriptional factor peroxisome proliferator-activated receptor gamma (PPARγ) is examined as it is a master regulator of adipocyte differentiation in mesenchymal stem cells (MSCs) that can also influence osteoblast populations. Obese individuals are known to have higher levels of PPARγ expression which contributes to their increased adipocyte numbers and decreased bone density. Modulating PPAR*gamma* signaling can have significant effects on adipogenesis, thereby directing MSCs down the osteoblastogenesis pathway and in turn increasing bone mineral density. Lastly, we explore the potential of PPARγ as a druggable target to decrease adiposity, increase bone density, and be a treatment for children with obesity-induced bone fractures.

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“…Murray y Wilson confirmaron una estrecha correlación entre el aumento de la obesidad infantil en los últimos 20 años en Escocia y una incidencia creciente de DEFP (38) . Por otro lado, según Halvarson y colaboradores, la obesidad no es un factor suficiente para el desarrollo de DEFP, por lo que podría existir un factor independiente, como podría ser la hiperleptinemia, que sea capaz de explicar la alteración en el funcionamiento fisario (39) . Como limitaciones del presente estudio se destaca su naturaleza retrospectiva, el bajo número de pacientes y el corto seguimiento clínico radiológico para lograr evaluar las complicaciones a largo plazo (coxartrosis).…”

Section: Discussionunclassified

Epifisiólisis de fémur proximal: Resultados y calidad de vida

Filippini

Pagano

Pérez

et al. 2020

RMU

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Leptin Elevation as a Risk Factor for Slipped Capital Femoral Epiphysis Independent of Obesity Status

Abstract: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 36 publications

References 84 publications

Fate of patients with slipped capital femoral epiphysis (SCFE) in later life: risk of obesity, hypothyroidism, and death in 2,564 patients with SCFE compared with 25,638 controls

Fate of patients with slipped capital femoral epiphysis (SCFE) in later life: risk of obesity, hypothyroidism, and death in 2,564 patients with SCFE compared with 25,638 controls

The role of PPARγ in childhood obesity-induced fractures

Epifisiólisis de fémur proximal: Resultados y calidad de vida

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