One broken bone in childhood raises risk for another

A new study of Canadian children finds that those who suffer a bone fracture are at increased risk of repeating a broken bone later in childhood or young adulthood.

In a population-based retrospective cohort study published in Pediatrics in July 2019, researchers in Ontario, Canada, examined health records of 2.5 million healthy children aged younger than 16 years during a baseline year of April 1, 2003, to March 31, 2004, for evidence of any bone fracture during the 1-year baseline period. Approximately 1.26 million of the cohort were boys; 1.2 million were girls. The incident was defined as a visit to an emergency department (ED) with a discharge diagnostic code representative of an acute bone fracture.

The primary outcome of the study was evidence of any additional fracture event during a 7-year follow-up observational period from April 1, 2004, to March 31, 2011, for a similar visit to a hospital ED with a discharge diagnostic code representing an acute fracture.

During the baseline year, 43,154 children experienced a bone fracture (17.5 fractures per 1000 child-years) and were placed in the baseline fracture cohort consisting of 1.6 million boys and 1.2 million girls. Of these children, 23.0% suffered at least 1 additional fracture during the 7-year follow-up period compared with 11.3% of children with no baseline fracture-a 60% higher rate of fracture during the follow-up period (incidence rate ratio: 1.60; 95% confidence interval: 1.46-1.75; P<.0001) compared with children who did not sustain a fracture in the baseline period. The higher incidence held across all ages after adjusting for sex, history of previous fracture, and occurrence of other head and soft-tissue injuries.

The researchers suggest that efforts to improve bone health be targeted at children who present with bone fracture risk factors, They voiced concerns that rising rates of low-energy bone fractures may be related to suboptimal bone health in childhood because of declining activity levels, worsening nutrition, and/or rising rates of childhood obesity, all factors that could lead to osteoporosis later in life. They suggest calcium and vitamin D supplementation, increasing protein and dairy intake, and increasing weight-bearing activity as beneficial interventions.