Associations of childhood overweight and obesity with upper-extremity fracture characteristics

Association of bone fracture with 30-year body mass index (BMI) trajectories: findings from the Framingham Heart Study : Bone fracture and 30-year BMI trajectories

A knowledge gap exists in associating later life's osteoporotic fracture and middle adulthood's BMI trajectories. We observed an association showing those transitioning from overweight to normal weight face a higher fracture risk in late adulthood, emphasizing the potential benefits of maintaining a stable BMI to reduce late-life fractures.

PURPOSE

Numerous studies on the relationship between obesity and fractures have relied on body mass index (BMI) at a single time point, yielding inconclusive results. This study investigated the association of BMI trajectories over middle adulthood with fracture risk in late adulthood.

METHODS

This prospective cohort study analyzed 1772 qualified participants from the Framingham Original Cohort Study, with 292 (16.5%) incident fractures during an average of 17.1-year follow-up. We constructed BMI trajectories of age 35-64 years based on latent class mixed modeling and explored their association with the risk of fracture after 65 years using the Cox regression.

RESULTS

The result showed that compared to the BMI trajectory Group 4 (normal to slightly overweight; see "Methods" for detailed description), Group 1 (overweight declined to normal weight) had a higher all-fracture risk after age 65 (hazard ratio [HR], 2.22, 95% CI, 1.13-4.39). The secondary analysis focusing on lower extremity fractures (pelvis, hip, leg, and foot) showed a similar association pattern.

CONCLUSIONS

This study suggested that people whose BMI slightly increased from normal weight to low-level overweight during 30 years of middle adulthood confer a significantly lower risk of fracture in later life than those whose BMI declined from overweight to normal weight. This result implies the potentially beneficial effects of avoiding weight loss to normal weight during middle adulthood for overweight persons, with reduced fracture risk in late life.

Is Adolescent Obesity Associated With a Higher Risk for Pelvic Fractures in Motor Vehicle Collisions?

INTRODUCTION

The impact of obesity on the incidence of blunt pelvic fractures in adults is unclear, and adolescents may have an increased risk of fracture due to variable bone mineral density and leptin levels. Increased subcutaneous adipose tissue may provide protection, though the association between obesity and pelvic fractures in adolescents has not been studied. This study hypothesized that obese adolescents (OAs) presenting after motor vehicle collision (MVC) have a higher rate of pelvic fractures, and OAs with such fractures have a higher associated risk of complications and mortality compared to non-OAs.

METHODS

The 2017-2019 Trauma Quality Improvement Program database was queried for adolescents (12-16 y old) presenting after MVC. The primary outcome was a pelvic fracture. Adolescents with a body mass index ≥30 (OA) were compared to adolescents with a body mass index <30 (non-OA). Subgroup analyses for high-risk and low-risk MVCs were performed. Multivariable logistic regression analyses were also performed adjusting for age and sex.

RESULTS

From 22,610 MVCs, 3325 (14.7%) included OAs. The observed rate of pelvic fracture was similar between all OA and non-OA MVCs (10.2% versus 9.4%, P = 0.16), as well as subanalyses of minor or high-risk MVC (both P > 0.05). OAs presenting with a pelvic fracture after high-risk MVC had a similar risk of complications, pelvic surgery, and mortality compared to non-OAs (all P > 0.05). However, OAs with a pelvic fracture after minor MVC had a higher associated risk of complications (OR 2.27, CI 1.10-4.69, P = 0.03), but a similar risk of requiring pelvic surgery, and mortality (all P > 0.05).

CONCLUSIONS

This national analysis found a similar observed incidence of pelvic fractures for OAs versus non-OAs involved in an MVC, including subanalyses of minor and high-risk MVC. Furthermore, there was no difference in the associated risk of morbidity and mortality except for OAs involved in a minor MVC had a higher risk of complication.

Evaluation of Risk Factors for the Occurrence of Limb Fractures in Children Due to Unintentional Injury in Podgorica, Montenegro, Mediterranean

Background and Objectives: Limb injuries in childhood are very common, with most of them being unintentional and often accompanied by soft tissue injuries. The aim of our study was to determine the risk factors that contribute to the occurrence of limb fractures as the most common type of accidental injury to children in our conditions. Materials and Methods: This study was designed as a prospective clinical analysis of predictive factors with a "nested" case-control study. It included all patients under the age of 18 who were diagnosed with unintentional limb injury and limb fracture due to accidental injury, at the Clinical Center of Montenegro, Podgorica, in the period of 7 January 2020-30 June 2021. Results: The gender of the child and the occurrence of the fracture are not related, and a statistically significant relationship was found between the occurrence of the fracture and the place of residence, the child's age, body mass index (BMI), the affected limb, the method of injury, and the mental state of the parents of the injured child, as well as their economic status. It was proved that the older the child was, the lower the chance of injury, while multivariate analysis proved that BMI could be a predictor of accidental fracture. The most common method of accidental limb fractures in children was a fall from a height. Conclusions: The analysis of factors that influence the occurrence of children's injuries is of great importance for public health. Such and similar research can enable a better understanding of the factors that influence accidental injuries, and therefore influence the prevention of these injuries by organizing various educational materials at the primary healthcare level or at the school level, for both children and parents.

Prevalence and factors associated with serious injuries and aggressive behaviours among in-school adolescents in Panama

Introduction

Injuries during adolescence cause lifelong harm and death. Our study used a nationally representative sample to examine the prevalence and risk factors associated with serious injuries among in-school adolescents in Panama.

Methods

We analysed Panama's 2018 Global School-Based Student Health Survey data using SPSS. Percentages were used to summarise the results of the prevalence of serious injuries. Binomial logistic regression analysis was performed to examine the risk factors of serious injuries. The results were presented as an adjusted odds ratio (AOR) at a 95% confidence interval (CI).

Results

The prevalence of serious injury among in-school adolescents in Panama is 45%. Furthermore, the study found that males (AOR= 1.495, CI=1.272--1.756), truancy (AOR=1.493, CI=1.249--1.785), overweight (AOR= 1.246, 95% CI=11.057--1.469), drinking alcohol (AOR= 1.397, CI=1.151--1.695), experiencing physical attack (AOR= 2.100, CI=11.646--2.681), engaging in a physical fight (AOR=1.586, CI=1.289--1.952) and bullied outside school (AOR=1.276, CI=1.005--1.621) significantly predict serious injuries among adolescents in Panama.

Conclusion

Multidisciplinary approaches targeting the correlates observed will help reduce the high prevalence of serious injuries among in-school adolescents in Panama.

Obese adolescents have higher risk for severe lower extremity fractures after falling

INTRODUCTION

Reports vary on the impact of obesity on the incidence of lower extremity fractures after a fall. We hypothesized that obese adolescents (OA) presenting after a fall have a higher risk of any and severe lower extremity fractures compared to non-OAs.

METHODS

A national database was queried for adolescents (12-17 years old) after a fall. Primary outcome included lower extremity fracture. Adolescents with a body mass index (BMI) ≥ 30 (OA) were compared to adolescents with a BMI < 30 (non-OA).

RESULTS

From 20,264 falls, 2523 (12.5%) included OAs. Compared to non-OAs, the rate of any lower extremity fracture was higher for OAs (51.5% vs. 30.7%, p < 0.001). This remained true for lower extremity fractures at all locations (all p < 0.05). After adjusting for sex and age, associated risk for any lower extremity fracture (OR 2.41, CI 2.22-2.63, p < 0.001) and severe lower extremity fracture (OR 1.31, CI 1.15-1.49, p < 0.001) was higher for OAs. This remained true in subset analyses of ground level falls (GLF) and falls from height (FFH) (all p < 0.05).

CONCLUSIONS

Obesity significantly impacts adolescents' risk of all types of lower extremity fractures after FFH or GLF. Hence, providers should have heightened awareness for possible lower extremity fractures in OAs.

LEVEL OF EVIDENCE

IV.

Influence of Obesity in Children with Supracondylar Humeral Fractures Requiring Surgical Treatment at a Tertiary Pediatric Trauma Center

BACKGROUND

Almost everywhere in the world, childhood obesity is becoming a serious public health problem with negative effects on both children's health and society as a whole. The main objective of this study was to determine whether obesity has an effect on the severity of supracondylar humerus fracture in children, regardless of whether it is a low- or high-energy trauma.

METHODS

The electronic records of patients treated for the supracondylar fracture of the humerus in the ten-year period from 1 January 2013 to 1 January 2023 were reviewed retrospectively.

RESULTS

In the observed period, 618 children, including 365 (59.06%) boys and 253 (40.94%) girls, were hospitalized and treated surgically with the diagnosis of supracondylar fracture. The distributions according to the observed parameters were as follows: age (months) = 88.18 ± 32.64; height (cm) = 123.42 ± 16.83; weight (kg) = 27.18 ± 11.32; body mass index = 17.18 ± 3.06; body mass index-for-age percentile = 57.34 ± 32.11. Overall, 141 (22.82%) fractures were classified as Gartland II, while 477 (77.18%) were classified as Gartland III. A total of 66 (10.68%) fractures were flexion type, while 552 (89.32%) were extension type. The left elbow was affected in 401 (64.89%) children, while the right was affected in 217 (35.11%) children. The main mechanism of injury was a fall at ground level (33.33%). In relation to gender, a statistically significant difference was recorded in body mass index and percentile (p < 0.05). According to Gartland, the proportion of children below and above the 85th percentile in relation to the type of injury was statistically significant (p < 0.05). It was determined that the energy level does not significantly influence the injury's severity: p(GII) = 0.225; p(GIII) = 0.180.

CONCLUSIONS

In our study, we found that the proportion of overweight and obese children requiring surgical treatment was higher in Gartland type III injury, so there is no doubt that as a society we must prevent further increases in the prevalence of childhood obesity for this reason as well.

Skeletal Outcomes in Children and Young Adults with Glomerular Disease

BACKGROUND

Children with glomerular disease have unique risk factors for compromised bone health. Studies addressing skeletal complications in this population are lacking.

METHODS

This retrospective cohort study utilized data from PEDSnet, a national network of pediatric health systems with standardized electronic health record data for more than 6.5 million patients from 2009 to 2021. Incidence rates (per 10,000 person-years) of fracture, slipped capital femoral epiphysis (SCFE), and avascular necrosis/osteonecrosis (AVN) in 4598 children and young adults with glomerular disease were compared with those among 553,624 general pediatric patients using Poisson regression analysis. The glomerular disease cohort was identified using a published computable phenotype. Inclusion criteria for the general pediatric cohort were two or more primary care visits 1 year or more apart between 1 and 21 years of age, one visit or more every 18 months if followed >3 years, and no chronic progressive conditions defined by the Pediatric Medical Complexity Algorithm. Fracture, SCFE, and AVN were identified using SNOMED-CT diagnosis codes; fracture required an associated x-ray or splinting/casting procedure within 48 hours.

RESULTS

We found a higher risk of fracture for the glomerular disease cohort compared with the general pediatric cohort in girls only (incidence rate ratio [IRR], 1.6; 95% CI, 1.3 to 1.9). Hip/femur and vertebral fracture risk were increased in the glomerular disease cohort: adjusted IRR was 2.2 (95% CI, 1.3 to 3.7) and 5 (95% CI, 3.2 to 7.6), respectively. For SCFE, the adjusted IRR was 3.4 (95% CI, 1.9 to 5.9). For AVN, the adjusted IRR was 56.2 (95% CI, 40.7 to 77.5).

CONCLUSIONS

Children and young adults with glomerular disease have significantly higher burden of skeletal complications than the general pediatric population.

Adiposity, Insulin Resistance, Cardiorespiratory Fitness, and Bone Health in Hispanic Children

CONTEXT

Childhood obesity disproportionately affects Hispanic youth. The skeletal system appears to be a target organ of the adverse effects of obesity. Yet, the relationship between adiposity and bone health in youth and the modulating factors are not well understood.

OBJECTIVE

This work aims to examine the relationship between adiposity, insulin resistance (IR), cardiorespiratory fitness (CRF), and bone mass in Hispanic youth.

METHODS

A total of 951 Hispanic youth (50% male), aged 4 to 19 years, participated in this cross-sectional design study from the Viva La Familia Study at Children's Nutrition Research Center. Bone mineral content (BMC) and density (BMD), lean mass (LM), total body fat mass (FM), truncal FM were obtained using dual-energy x-ray absorptiometry. Fasting glucose and insulin were obtained and the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. CRF was measured using a treadmill ramp protocol. We applied linear regression models and mediation analyses.

RESULTS

Adiposity measures were negatively related to BMC and BMD after accounting for LM and sex. IR negatively contributed whereas CRF positively contributed to the variance in BMC and BMD, more notably in the pubertal age group. In mediation analysis, HOMA-IR partially mediated the negative relationship of adiposity to BMC (standardized indirect effect [IE] = -0.0382; 95% CI, -0.0515 to -0.0264) whereas the sequential IE of HOMA-IR and CRF partially attenuated (IE = -0.0026; 95% CI, -0.0053 to -0.0005) this relationship. Similar findings were seen with BMD as the primary outcome.

CONCLUSION

IR mediates the negative relationship between adiposity and bone mass whereas CRF may partially attenuate it.

One-Year Prospective Association of BMI with Later Cognitive Development in Preschoolers

This study examined the prospective relationships between preschoolers’ body mass index (BMI) and cognitive development. BMI, cognitive (i.e., Brigance), sex, and age data were collected from seven cohorts of children attending Head Start from 2012 to 2018. Children (N = 324) with two years of complete data were included. After controlling for the first year cognitive development scores, age, gender, and the cohort, the BMI was predictive of lower cognitive development scores in year two (B = −0.06, β = −0.14, t = −3.19, p = 0.002). Female sex (B = 2.69, β = 0.10, t = 2.30, p = 0.022) and older age (B = 0.02, β = 0.15, t = 3.20, p ≤ 0.001) were also shown to be statistically significant predictors of improved year two cognitive scores. The initial BMI scores were associated with poorer one year cognitive development scores in this sample of preschool children. Excessive body mass may contribute to numerous biological, psychological, and social factors that inhibit children with obesity from reaching their full cognitive potential, during a time in which brain development and cognitive skills development are at critical points of growth. Early childhood obesity interventions may have positive consequences for cognitive development, but additional prospective studies are needed to confirm these results.

Severe Infraclavicular Displacement of a Proximal Humerus Fracture with Concomitant Olecranon Fracture in a Pediatric Patient

Proximal humerus fractures with severe medial displacement of the humeral head are rare in adults and especially so in children. Concomitant vascular/neurovascular injury is even more uncommon but must be considered as the associated complications can carry significant morbidity. We present a case of a 12-year-old transported to the ED after a mountain bike accident in which she lost control and hit a cement wall, injuring her left upper extremity (LUE). Despite a normal vascular/sensory exam, imaging demonstrated a left comminuted proximal humerus fracture with the humerus displaced medially into the thoracic inlet as well as concern for left subclavian vessel injury. Given the possibility of vascular injury and the severe humeral head displacement, she was taken to surgery with orthopedic and vascular surgical teams. Although surgical exploration did not reveal vascular injury, this case underlines the importance of maintaining a high index of suspicion for neurovascular injury with such fractures as prompt intervention may reduce the likelihood of complications. This case also underscores the need for further research into the management of pediatric proximal humerus fractures in early adolescence.

Obesity and Bone: A Complex Relationship

There is a large literature on the relationship between obesity and bone. What we can conclude from this review is that the increase in body weight causes an increase in BMD, both for a mechanical effect and for the greater amount of estrogens present in the adipose tissue. Nevertheless, despite an apparent strengthening of the bone witnessed by the increased BMD, the risk of fracture is higher. The greater risk of fracture in the obese subject is due to various factors, which are carefully analyzed by the Authors. These factors can be divided into metabolic factors and increased risk of falls. Fractures have an atypical distribution in the obese, with a lower incidence of typical osteoporotic fractures, such as those of hip, spine and wrist, and an increase in fractures of the ankle, upper leg, and humerus. In children, the distribution is different, but it is not the same in obese and normal-weight children. Specifically, the fractures of the lower limb are much more frequent in obese children. Sarcopenic obesity plays an important role. The authors also review the available literature regarding the effects of high-fat diet, weight loss and bariatric surgery.