Summary

Childhood fracture is common, but whether it predicts adult fracture is not clear. Repeat childhood fracture was associated with adult (≤ 45 years) fracture, and in women, lower areal bone density was associated with repeat childhood fracture. Identifying fracture-prone children can modify adult fracture risk management.

Introduction

A quarter of boys and 15% of girls will suffer multiple fractures, but it is not clear whether multiple fractures during growth predict fracture risk and areal bone density in adulthood. This study evaluated whether children who repeatedly fracture were at increased risk of low areal bone density, abnormal body composition, and fractures by age 45.

Methods

A subsample of a large birth cohort study with childhood fracture cases had areal bone density assessed at age 45 years. Participants were questioned regularly across their lifetime about fractures during childhood (ages 0–18 years of age) and adulthood (any fracture between 18 and 45 years). The number of fractures was collapsed into three categories: no fractures; 1 fracture; and > 1 fracture, separately for child and adult groups.

Results

At age 45 years, areal bone mineral density (g/cm²) and body composition were measured with dual X-ray absorptiometry in n = 555 participants. Compared to no fractures, twice as many girls (14% vs 7%, P = 0.156) and boys (31.4% vs 14.1%, P = 0.004) who repeatedly fractured in childhood sustained multiple fractures as adults. Both girls and boys who were fracture-free tended to remain fracture-free as adults (79.8% compared with 62.8%, P = 0.045, and 64.8% compared with 51.4%, P = 0.025, in males and females, respectively). Participants were more than twice as likely to fracture repeatedly as adults if they had sustained multiple fractures as a child (OR 2.5 95% CI: 1.4, 4.6). Women who repeatedly fractured during childhood had lower areal bone density, whereas repeated fracturing during childhood was not associated with areal bone density or body composition in men, even after adjustment for other factors known to influence fracture history.

Conclusion

Childhood fracture history is associated with persistent skeletal fragility in adulthood (≤ 45 years), even after adjustment for behavioral and demographic factors known to influence fracture history.

中文翻译：

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儿童反复骨折与中年面积骨密度或身体成分有关吗？

概括

儿童期骨折很常见，但它是否预示着成人骨折尚不清楚。儿童期反复骨折与成人（≤ 45 岁）骨折有关，而在女性中，较低的面积骨密度与儿童期反复骨折有关。识别容易骨折的儿童可以修改成人骨折风险管理。

介绍

四分之一的男孩和 15% 的女孩会遭受多处骨折，但尚不清楚生长期间的多处骨折是否能预测成年期的骨折风险和面积骨密度。这项研究评估了反复骨折的儿童在 45 岁时是否会增加面积骨密度低、身体成分异常和骨折的风险。

方法

一项针对儿童骨折病例的大型出生队列研究的子样本在 45 岁时评估了面积骨密度。参与者在其一生中定期接受有关儿童期（0-18 岁）和成年期（18 至 45 岁之间的任何骨折）骨折的询问。骨折数量分为三类：无骨折；1处骨折；> 1 处骨折，分别针对儿童组和成人组。

结果

在 45 岁时，用双 X 射线吸收法测量了n  = 555 名参与者的面积骨矿物质密度 (g/cm ^{2 ) 和身体成分。}与没有骨折相比， 在儿童时期反复骨折的女孩（14% 对 7%， P  = 0.156）和男孩（31.4% 对 14.1%，P = 0.004）与成人一样多处骨折。没有骨折的女孩和男孩在成年后都倾向于保持无骨折（ 男性和女性分别为 79.8% 和 62.8%， P  = 0.045 和 64.8% 和 51.4%，P = 0.025）。如果参与者在儿童时期遭受多处骨折，他们反复骨折的可能性是成年人的两倍多（或2.5 95% CI：1.4, 4.6)。儿童时期反复骨折的女性骨密度较低，而儿童时期反复骨折与男性的面积骨密度或身体成分无关，即使在调整了其他已知影响骨折史的因素后也是如此。

结论

儿童骨折史与成年期（≤ 45 岁）持续的骨骼脆弱性相关，即使在调整了已知会影响骨折史的行为和人口因素后也是如此。