A case control study to determine the association between Perthes’ disease and the recalled use of tobacco during pregnancy, and biological markers of current tobacco smoke exposure

Abstract

Aims It is well established that there is a strong association between Perthes’ disease and worsening socioeconomic deprivation. It has been suggested that the primary determinant driving this association is exposure to tobacco smoke. This study aimed to examine this hypothesis. Patients and Methods A hospital case-control study (n = 149/146) examined the association between tobacco smoke exposure and Perthes’ disease, adjusting for area-level socioeconomic deprivation. Tobacco smoke exposure was assessed by parental questionnaire of smoking habits during pregnancy, and by quantitative assay of current exposure using the urinary cotinine-creatinine ratio, which is a widely used and validated measure of tobacco smoke exposure. Results The odds of Perthes’ disease significantly increased with reported in utero exposure after adjustment for socioeconomic deprivation (maternal smoking odds ratio (OR) 2.06, 95% confidence interval (CI) 1.17 to 3.63; paternal smoking OR 2.09, 95% CI 1.26 to 3.46). The cotinine-creatinine ratio was significantly greater in cases, OR 1.63 (95% CI 1.09 to 2.43), suggesting a greater ‘dose’ of current tobacco exposure. Conclusion An association exists between tobacco smoke exposure and Perthes’ disease but we remain unable to disentangle the association with socioeconomic deprivation. Cite this article: Bone Joint J 2017;99-B:1102–8.

Aetiology of Legg-Calvé-Perthes disease: A systematic review

“…Their results supported the presence of environmental or genetic factors but not low birthweight. Similar results were reported by other epidemiological studies[12-16].…”

“…While other environmental factors may be present, smoking seems to one of the most reported risk factor for developing LCPD[11-16]. In particular, Perry et al[12] recently showed how maternal smoking can affect the risk of developing the disease in a case control study. In addition to this, another four studies[13-16] report evidence of the association between environmental smoke and LCPD, both during maternal pregnancy and the childhood of the patient.…”

“…Thus, low birthweight could be often falsely associated with LCPD because of the smoking habit typically present in these families, which is the more probable cause of the higher incidence of LCPD. For these reasons, the role of low birth weight lacks strong evidence[12-17,29], and the smoking habit, being more common in social-economical deprived families, may play a more important role in the etiopathogenesis of LCPD. This was further confirmed by studies investigating the association between smoking and LCPD, which reported a significant augmentation of the risk in smokers and smoke-exposed family.…”

New insights into the biomechanics of Legg-Calvé-Perthes’ disease

“…Legg–Calvé–Perthes’ disease (LCP or Perthes’ disease) is an idiopathic osteonecrosis of the femoral head that most frequently occurs between four and eight years old. 1 , 2 Although described more than 100 years ago by four independent studies, 3 - 6 the aetiology of Perthes’ disease remains poorly understood. LCP is between four and five times more common in boys than in girls, and children with this disease have delayed skeletal development of between one and two years.…”

CORR Insights®: What are the Demographics and Epidemiology of Legg-Calvé-Perthes Disease in a Large Southern California Integrated Health System?

“…Where Do We Need To Go? head, the underlying etiology for LCPD is unknown, although hypercoagulability, hyperactivity, gymnastics, toxic synovitis, femoral retroversion, body weight, socioeconomic status, and smoke exposure all have been implicated [10,13]. A first step in treating a disease is understanding the cause and precipitating risk factors.…”