Association between bone mass and fractures in children: a prospective cohort study.

J Bone Miner Res 2006 Sep;21(9):1489-95

Community Based Medicine, University of Bristol, Bristol, United Kingdom.

Unlabelled: This is the first prospective cohort study of the association between bone mass and fracture risk in childhood. A total of 6213 children 9.9 years of age were followed for 24 months. Results showed an 89% increased risk of fracture per SD decrease in size-adjusted BMC.

Introduction: Although previous case-control studies have reported that fracture risk in childhood is inversely related to bone mass, this has not been confirmed in prospective studies. Additionally, it remains unclear which constituent(s) of bone mass underlie this association. We carried out a prospective cohort study to examine the relationship between DXA measures in children 9.9 years of age and risk of fracture over the following 2 years.

Materials And Methods: Total body DXA scan results obtained at 9.9 years of age were linked to reported fractures over the following 2 years in children from a large birth cohort in southwest England. DXA measures consisted of total body less head (TBLH) BMD, bone area, and BMC, and results of subregional analysis of the humerus. Analyses were adjusted for age, sex, ethnicity, and social position.

Results: Complete data were available on 6213 children. There was a weak inverse relationship between BMD at 9.9 years and subsequent fracture risk (OR per SD decrease = 1.12; 95% CI, 1.02-1.25). In analyses examining the relationship between fracture risk and volumetric BMD, fracture risk was inversely related to BMC adjusted for bone area, height, and weight (OR = 1.89; 95% CI, 1.18-3.04) and to estimated volumetric BMD of the humerus (OR = 1.29; 95% CI, 1.14-1.45). Fracture risk was unrelated to both TBLH and humeral bone area. However, in analyses of the relationship between fracture risk and bone size relative to body size, an inverse association was observed between fracture risk and TBLH area adjusted for height and weight (OR = 1.51; 95% CI, 1.17-1.95).

Conclusions: Fracture risk in childhood is related to volumetric BMD, reflecting an influence of determinants of volumetric BMD such as cortical thickness on skeletal fragility. Although bone size per se was not related to fracture risk, we found that children who fracture tend to have a smaller skeleton relative to their overall body size.

Download full-text PDF

Source
http://doi.wiley.com/10.1359/jbmr.060601
Publisher Site
http://dx.doi.org/10.1359/jbmr.060601DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742714PMC
September 2006
6 Reads

Publication Analysis

Top Keywords

fracture risk
40
volumetric bmd
16
bone mass
16
fracture
13
cohort study
12
bone area
12
prospective cohort
12
risk childhood
12
risk
12
years age
12
bone
8
dxa measures
8
relationship fracture
8
association bone
8
bone size
8
relative body
8
body size
8
height weight
8
6213 children
8
children years
8

Similar Publications