Prematurity Does Not Increase Early Childhood Fracture Risk

Wagner, Kari L.; Wagner, Scott C.; Susi, Apryl; Gorman, Gregory; Hisle-Gorman, Elizabeth

doi:10.1016/j.jpeds.2018.11.017

Cited by 10 publications

(17 citation statements)

References 38 publications

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“…Our study did not demonstrate a statistically significant increased risk of childhood fractures for boys. This is different from Wagner et al [10], who found in their adjusted analysis that independent associations of increased rate of fracture in the first 5 years of life include being male. The male gender was associated with a 9% increase in the rate of fracture within the age group of 2-5 years, independent of prematurity status.…”

Section: Discussioncontrasting

confidence: 79%

“…In Topor et al [18], unadjusted for confounders, premature infants sustained more fractures than term infants, and any increased risk of fractures as compared to term infants was limited to those younger than age 2. A higher fracture incidence in preterm infants was found in Wagner et al [10], but it would appear that any increased fracture risk, even after controlling for confounders, exists only in early infancy and only for preterm infants born at less than 28 weeks' gestational age.…”

Section: Discussionmentioning

confidence: 62%

“…However, none of the studies above excluded premature infants with known metabolic bone disease of prematurity and thus had an increased risk of fractures. Wagner et al [10] are the only group we are aware of that has statistically adjusted study results to control for comorbidities or medications that may affect bone health. They included more than 65,000 children and found no increased risk of fractures in premature children up to the age of 5.…”

Section: Discussionmentioning

confidence: 99%

“…Infants with metabolic bone disease have an increased early infancy fracture risk, with an estimated 10% of very low birth weight infants and 33% of extremely low birth weight infants sustaining fractures within the first 6 months of life [5,8]. Several studies have reported that any differences in bone mineralisation between preterm and term infants are resolved by 2 years of age [9][10][11], and any fractures associated with metabolic bone disease of prematurity usually occur within the first year of life [12]. An increased risk of fractures in preterm infants after this period is unproven.…”

Section: Introductionmentioning

confidence: 99%

“…It is important to note that most of these studies took place more than two decades ago. Additionally, only one study that we know of has accounted for metabolic bone disease as a potential confounding factor [10]. There is also a lack of data in the literature on differences (if any) between clinical presentation and features of fractures in the preterm and term populations.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of prevalence and characteristics of fractures in term and preterm infants in the first 3 years of life

et al. 2020

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Background Preterm infants may be more vulnerable to fractures due to various factors, including metabolic bone disease, but an increased risk of fractures up to the age of 2 is unproven. Objective To compare fracture patterns in premature and full-term children in the first 3 years of life. Materials and methods A retrospective study was conducted. We excluded any child who returned with the same injury, with known metabolic bone disease, with any disease or condition known to reduce bone density, who received any medication known to affect Vitamin D metabolism within 3 months of enrollment or who had fractures post-surgery/resuscitation. Variables such as the number of fractures sustained each year, age of presentation to the Emergency Department and mechanism of injury were compared between the preterm and term groups using statistical analysis (χ2 and Fisher exact test for categorical variables and Student’s t-test for continuous variables). Simple linear regression was performed on the total number of fractures sustained by age 3. Results Forty-four children with fractures were included. Of these, none were born extremely preterm, 24 (55%) were preterm, and 20 (45%) were born at term. Mean gestational ages of the preterm and term groups were 32 weeks 3 days and 39 weeks 6 days, respectively. There were no extremely low birth weight or very low birth weight children. There was no significant difference in the number of fractures sustained yearly, the age of presentation to the Emergency Department or the site of fracture between preterm and term groups. Linear regression showed that the total number of fractures sustained by age 3 years was unrelated to prematurity status, gender or birth weight category. Conclusion No significant difference in fracture number or pattern was identified.

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Section: Discussioncontrasting

confidence: 79%

Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of prevalence and characteristics of fractures in term and preterm infants in the first 3 years of life

et al. 2020

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Association Between Proton Pump Inhibitor Use and Risk of Fracture in Children

et al. 2020

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IMPORTANCE Proton pump inhibitor (PPI) use has been linked to increased risk of fracture in adults. Despite a trend in prescription of PPIs in children, there is scarce evidence regarding this safety concern in pediatric patients. OBJECTIVE To evaluate the association between PPI use and risk of fracture in children. DESIGN This nationwide register-based cohort study included data from Sweden from July 2006 to December 2016. Children younger than 18 years who initiated PPI use were matched on propensity score and age with those who did not initiate PPI use. EXPOSURE Initiation of PPI use. MAIN OUTCOMES AND MEASURESCox regression was adopted to estimate hazard ratios (HRs) for a first fracture of any type and 5 subtypes of fracture, with follow-up for up to 5 years. To address potential residual confounding, high-dimensional propensity score matching and a direct comparison with histamine-2 receptor antagonists were performed.RESULTS There were a total of 115 933 pairs of children included. During a mean (SD) of 2.2 (1.6) years of follow-up, 5354 and 4568 cases of any fracture occurred among those who initiated PPIs vs those who did not, respectively (20.2 vs 18.3 events per 1000 person-years; hazard ratio [HR], 1.11 [95% CI, 1.06-1.15]). Use of PPIs was associated with increased risk of upper-limb fracture (HR, 1.08 [95% CI, 1.03-1.13]), lower-limb fracture (HR, 1.19 [95% CI, 1.10-1.29]), and other fractures (HR, 1.51 [95% CI, 1.16-1.97]) but not head fracture (HR, 0.93 [95% CI, 0.76-1.13]) or spine fracture (HR, 1.31 [95% CI,). The HRs for fracture according to cumulative duration of PPI use were 1.08 (95% CI, 1.03-1.13) for 30 days or less, 1.14 (95% CI, 1.09-1.20) for 31 to 364 days, and 1.34 (95% CI, 1.13-1.58) for 365 days or more. The association was consistent in most sensitivity analyses, including high-dimensional propensity score matching (HR, 1.10 [95% CI, 1.06-1.15]), although the analysis of PPI vs histamine-2 receptor antagonist did not reach statistical significance (HR, 1.06 [95% CI, 0.97-1.15]). CONCLUSIONS AND RELEVANCEIn this large pediatric cohort, PPI use was associated with a small but significant increased risk of any fracture. Risk of fracture should be taken into account when weighing the benefits and risks of PPI treatment in children.

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Association of Preterm Birth and Low Birthweight with Bone Fractures during Childhood

Kuitunen

Sund

Sankilampi

2023

J of Bone & Mineral Res

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Preterm birth and low birthweight have been associated with increased fracture risk in children. Our aim was to analyze bone fractures during childhood in preterm, and low‐birthweight newborns compared to full‐term and normal‐birthweight newborns. We conducted a nationwide register‐based cohort study in Finland from 1998 to 2017 and utilized the Medical Birth Register and Care Register for Health Care. All newborns alive 28 days after birth were included, and data on all fracture visits in specialized healthcare units were gathered. Incidences per 100,000 person‐years with 95% confidence intervals (CI) were calculated, and comparisons were made by incidence rate ratios (IRRs). Kaplan–Meier analysis was used to analyze the timing of fractures during childhood (0–20 years). We included a total of 997,468 newborns and 95,869 fractures; the mean follow‐up was 10.0 years, and the overall incidence of fractures was 963 per 100,000 person‐years. Very preterm (<32 gestational weeks) newborns had 23% lower fracture incidence than term newborns (IRR 0.77; CI: 0.70–0.85). Preterm newborns (32 to 36 gestational weeks) had a fracture rate (IRR 0.98; CI: 0.95–1.01) similar to that of term newborns. Birthweight showed a linear increase in the fracture rates as newborns with birthweight less than 1000 g had the lowest fracture incidence of 773 per 100,000 person‐years and the highest incidence (966 per 100,000 person‐years) was among newborns with birthweight 2500 g or more. Children born very preterm or with extremely low birthweight have in general a lower fracture incidence during childhood compared to children born full term and with normal birthweight. These findings possibly reflect, in addition to improvements of neonatal intensive care and early nutrition, the fact that childhood fracture incidences are more dependent on issues other than early life events. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

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Prematurity Does Not Increase Early Childhood Fracture Risk

Cited by 10 publications

References 38 publications

Comparison of prevalence and characteristics of fractures in term and preterm infants in the first 3 years of life

Comparison of prevalence and characteristics of fractures in term and preterm infants in the first 3 years of life

Association Between Proton Pump Inhibitor Use and Risk of Fracture in Children

Association of Preterm Birth and Low Birthweight with Bone Fractures during Childhood

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