In the Journals

Pediatric fracture risk varies by ethnicity

Children with European ancestry are twice as likely to sustain a fracture vs. Asian children and 1.5 times more likely to experience a fracture vs. children with African ancestry, with no differences observed between boys vs. girls, according to findings published in Bone.

“In the present study, we observed higher [bone mineral density] in African children but lower BMD in Asian children when compared to Europeans,” Carolina Medina-Gomez, PhD, a biostatistician in the department of internal medicine at Erasmus University Medical Center in Rotterdam, the Netherlands, and colleagues wrote. “European children had a higher risk of prevalent fracture than both Asian and African children, even after the adjustment for BMD. Additionally, our sensitivity analyses, including a questionnaire-based assessment of physical activity for each child, did not suggest that exercise levels explained differences in fracture risk of Asian children as compared to European children.”

Medina-Gomez and colleagues analyzed data from 3,632 children with available fracture and ethnicity information participating in the Generation R study, a multiethnic, population-based pregnancy cohort in Rotterdam (50.7% girls; mean age, 10 years; 87.1% European). Children underwent whole-body DXA scans (mean age, 9.7 years) to assess lean mass, lean mass fraction (division of lean mass by weight) and total body less head BMD. Researchers assessed prevalent fracture and physical activity data via parent questionnaires and used logistic regression analysis to estimate the association between fracture occurrence and sex or ethnicity, with adjustments for age, weight, lean mass and BMD.

Within the cohort, at least one fracture was reported in 525 children (14.5%), including 13.9% of girls and 15.1% of boys, with 84 (16%) reporting more than one fracture. Most children sustained the first fracture in the arm or wrist (54%), followed by 18% of fractures in the leg or ankle. There were no between-group differences in age, weight, height or lean mass fraction among children who did and did not sustain a fracture.

Researchers did not observe a between-sex difference for fracture risk, even after adjustment for possible confounders (OR = 1.03; 95% CI, 0.84-1.27). However, researchers found that European children were two times more likely to experience a fracture vs. Asian children (OR = 2.1; 95% CI, 1.17-3.45) and 1.5 times more likely to experience a fracture vs. African children (OR = 1.5; 95% CI, 1-2.26).

Researchers also performed an analysis with 2,360 children who underwent a genetically determined ancestry assessment, including 2,171 European children, 62 Asian children, 105 African children and 22 children with mixed ancestry. In that analysis, researchers did not observe significant between-group differences in fracture risk (P > .1, excluding children of mixed ancestry); however, they observed a trend for lower fracture risk among children with a higher percentage of Asian ancestry (P = .08).

“Given the small number of non-European children in the Generation R study, caution is required in the interpretation of the current findings,” the researchers wrote. “The lack of association between sex and pediatric fracture — even in our well-powered study — could be specific to the age at which our assessment was made and should be addressed in future studies.” – by Regina Schaffer

Disclosures: The authors report no relevant financial disclosures.

Children with European ancestry are twice as likely to sustain a fracture vs. Asian children and 1.5 times more likely to experience a fracture vs. children with African ancestry, with no differences observed between boys vs. girls, according to findings published in Bone.

“In the present study, we observed higher [bone mineral density] in African children but lower BMD in Asian children when compared to Europeans,” Carolina Medina-Gomez, PhD, a biostatistician in the department of internal medicine at Erasmus University Medical Center in Rotterdam, the Netherlands, and colleagues wrote. “European children had a higher risk of prevalent fracture than both Asian and African children, even after the adjustment for BMD. Additionally, our sensitivity analyses, including a questionnaire-based assessment of physical activity for each child, did not suggest that exercise levels explained differences in fracture risk of Asian children as compared to European children.”

Medina-Gomez and colleagues analyzed data from 3,632 children with available fracture and ethnicity information participating in the Generation R study, a multiethnic, population-based pregnancy cohort in Rotterdam (50.7% girls; mean age, 10 years; 87.1% European). Children underwent whole-body DXA scans (mean age, 9.7 years) to assess lean mass, lean mass fraction (division of lean mass by weight) and total body less head BMD. Researchers assessed prevalent fracture and physical activity data via parent questionnaires and used logistic regression analysis to estimate the association between fracture occurrence and sex or ethnicity, with adjustments for age, weight, lean mass and BMD.

Within the cohort, at least one fracture was reported in 525 children (14.5%), including 13.9% of girls and 15.1% of boys, with 84 (16%) reporting more than one fracture. Most children sustained the first fracture in the arm or wrist (54%), followed by 18% of fractures in the leg or ankle. There were no between-group differences in age, weight, height or lean mass fraction among children who did and did not sustain a fracture.

Researchers did not observe a between-sex difference for fracture risk, even after adjustment for possible confounders (OR = 1.03; 95% CI, 0.84-1.27). However, researchers found that European children were two times more likely to experience a fracture vs. Asian children (OR = 2.1; 95% CI, 1.17-3.45) and 1.5 times more likely to experience a fracture vs. African children (OR = 1.5; 95% CI, 1-2.26).

Researchers also performed an analysis with 2,360 children who underwent a genetically determined ancestry assessment, including 2,171 European children, 62 Asian children, 105 African children and 22 children with mixed ancestry. In that analysis, researchers did not observe significant between-group differences in fracture risk (P > .1, excluding children of mixed ancestry); however, they observed a trend for lower fracture risk among children with a higher percentage of Asian ancestry (P = .08).

“Given the small number of non-European children in the Generation R study, caution is required in the interpretation of the current findings,” the researchers wrote. “The lack of association between sex and pediatric fracture — even in our well-powered study — could be specific to the age at which our assessment was made and should be addressed in future studies.” – by Regina Schaffer

Disclosures: The authors report no relevant financial disclosures.