Association Between Upper Extremity Fractures and Weight Status in Children

Singer, Steven A.; Chamberlain, James M.; Tosi, Laura L.; Teach, Stephen J.; Ryan, Leticia Manning

doi:10.1097/pec.0b013e318226c840

Cited by 5 publications

(8 citation statements)

References 31 publications

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“…Secondary analysis in this study showed that associated fracture risk varied depending upon anatomical location, with increased risk associated with distal limb fractures. Previous work in children has also suggested a higher rate of distal upper limb fractures in children with a high BMI compared with other anatomical sites . By comparison, research in adults has found excess risk of distal upper limb fractures associated with an overweight or obese BMI in women (in some studies after adjustment for bone mineral density), and fewer distal fractures in men with increased weight …”

Section: Discussionmentioning

confidence: 96%

“…Chronic kidney disease, low bone mineral density, glucocorticoid use, vitamin D deficiency, and dietary factors have been implicated in the pathophysiology of fracture . Vitamin D deficiency has been associated with childhood obesity, obesity being implicated in pediatric fracture pathophysiology in retrospective clinical and basic science studies …”

Section: Introductionmentioning

confidence: 99%

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Preschool Obesity Is Associated With an Increased Risk of Childhood Fracture: A Longitudinal Cohort Study of 466,997 Children and Up to 11 Years of Follow-up in Catalonia, Spain

Lane

Butler

Poveda-Marina

et al. 2020

Journal of Bone and Mineral Research

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This study aimed to determine if having an overweight or obese range body mass index (BMI) at time of beginning school is associated with increased fracture incidence in childhood. A dynamic cohort was created from children presenting for routine preschool primary care screening, collected in the Information System for Research in Primary Care (SIDIAP) platform in Catalonia, Spain. Data were collected from 296 primary care centers representing 74% of the regional pediatric population. A total of 466,997 children (48.6% female) with a validated weight and height measurement within routine health care screening at age 4 years (±6 months) between 2006 and 2013 were included, and followed up to the age of 15, migration out of region, death, or until December 31, 2016. BMI was calculated at age 4 years and classified using WHO growth tables, and fractures were identified using previously validated ICD10 codes in electronic primary care records, divided by anatomical location. Actuarial lifetables were used to calculate cumulative incidence. Cox regression was used to investigate the association of BMI category and fracture risk with adjustment for socioeconomic status, age, sex, and nationality. Median follow‐up was 4.90 years (interquartile range [IQR] 2.50 to 7.61). Cumulative incidence of any fracture during childhood was 9.20% (95% confidence interval [CI] 3.79% to 14.61%) for underweight, 10.06% (9.82% to 10.29%) for normal weight, 11.28% (10.22% to 12.35%) for overweight children, and 13.05% (10.69% to 15.41%) for children with obesity. Compared with children of normal range weight, having an overweight and obese range BMI was associated with an excess risk of lower limb fracture (adjusted hazard ratio [HR] = 1.42 [1.26 to 1.59]; 1.74 [1.46 to 2.06], respectively) and upper limb fracture (adjusted HR = 1.10 [1.03 to 1.17]; 1.19 [1.07 to 1.31]). Overall, preschool children with an overweight or obese range BMI had increased incidence of upper and lower limb fractures in childhood compared with contemporaries of normal weight. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Preschool Obesity Is Associated With an Increased Risk of Childhood Fracture: A Longitudinal Cohort Study of 466,997 Children and Up to 11 Years of Follow-up in Catalonia, Spain

Lane

Butler

Poveda-Marina

et al. 2020

Journal of Bone and Mineral Research

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“…Lower limb fractures are the most common type of fractures in maltreated or neglected children, who are also typically younger than accidental trauma patients (Ghanem et al, 2018). Extremity fractures have also been associated with being underweight (Sabhaney et al, 2014) and overweight (Singer et al, 2011). Although risperidone and aripiprazole are both associated with weight gain, evidence on the whole shows weight gain is higher with risperidone exposure, so perhaps weight gain in some children with ASD is protective for fractures (Almandil et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

Risperidone versus aripiprazole fracture risk in children and adolescents with autism spectrum disorders

et al. 2021

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Risperidone and aripiprazole, commonly used antipsychotics in children with autism spectrum disorder (ASD), have previously been associated with elevated fracture risk in other populations. The aim of this study was to evaluate and compare the risk of fracture among children with ASD using risperidone or aripiprazole. This was a retrospective, propensity‐score matched cohort study, set between January 2013 and December 2018. We used the MarketScan Medicaid insurance data, which covers multiple states of the United States. We included ASD children aged 2–18 years, who were new users of aripiprazole or risperidone and with no prior history of antipsychotic use or fractures. The main exposure was the continued use of aripiprazole or risperidone. The incidence rates of any fracture during follow‐up were evaluated, and the risk between aripiprazole and risperidone was compared via Cox‐proportional hazard models. Results were stratified by age, sex, duration of exposure and fracture site. In total, 3312 patients (78% male; mean [SD] age 11.0 [3.7] years) were identified for each cohort. Over the full duration of follow‐up, fracture incidence rates per 1000 patient‐years were 23.2 for risperidone and 38.4 for aripiprazole (hazard ratio and 95% confidence interval: 0.60 [0.44–0.83]). Risks were similar between cohorts throughout the first 180 days on treatment, but significantly higher in the aripiprazole group thereafter. Extremity fractures drove most of the increased risk, with the biggest differences in lower leg and ankle fractures. Differences widened for children aged 10 years or younger (HR [95% CI]: 0.47 [0.30–0.74]). In conclusion, compared to aripiprazole, risperidone was associated with 40% lower risk of fracture. Further analysis on the mechanism and long‐term bone health of antipsychotic‐treated children with ASD is warranted. Lay summary We compared the risk of bone fractures among 6624 children with autism spectrum disorder (ASD), half of whom used risperidone and half of whom used aripiprazole. Taking other factors into account, risks were similar between the two groups throughout the first 180 days on treatment, but significantly higher in the aripiprazole group thereafter. The biggest differences were in lower leg and ankle fractures. Overall, compared with aripiprazole, risperidone was associated with 40% lower risk of fracture.

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“…Previous studies have demonstrated an association between increased weight status and upper extremity fracture in the 5- to 9-year age group, 26 but an association, if any, on severity of fracture was not reported. Similarly, obesity has also been associated with increased forearm fracture risk specifically from minor trauma during childhood.…”

Section: Discussionmentioning

confidence: 86%

Is High Weight Status Associated with Pediatric Forearm Fractures Requiring Anatomic Reduction?

Ryan

Teach

Ezeibe

et al. 2015

Journal of Investigative Medicine

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Association Between Upper Extremity Fractures and Weight Status in Children

Cited by 5 publications

References 31 publications

Preschool Obesity Is Associated With an Increased Risk of Childhood Fracture: A Longitudinal Cohort Study of 466,997 Children and Up to 11 Years of Follow-up in Catalonia, Spain

Preschool Obesity Is Associated With an Increased Risk of Childhood Fracture: A Longitudinal Cohort Study of 466,997 Children and Up to 11 Years of Follow-up in Catalonia, Spain

Risperidone versus aripiprazole fracture risk in children and adolescents with autism spectrum disorders

Is High Weight Status Associated with Pediatric Forearm Fractures Requiring Anatomic Reduction?

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