Increasing wrist fracture rates in children may have major implications for future adult fracture burden

Abstract

Background and purpose - Childhood fractures are associated with lower peak bone mass (a determinant of osteoporosis in old age) and higher adult fracture risk. By examining time trends in childhood fracture epidemiology, it may be possible to estimate the vector of fragility fracture risk in the future. Patients and methods - By using official inpatient and outpatient data from the county of Skåne in Sweden, 1999-2010, we ascertained distal forearm fractures in children aged ≤ 16 years and estimated overall and age- and sex-specific rates and time trends (over 2.8 million patient years) and compared the results to earlier estimations in the same region from 1950 onwards. Results - During the period 1999-2010, the distal forearm fracture rate was 634 per 10(5) patient years (750 in boys and 512 in girls). This was 50% higher than in the 1950s with a different age-rate distribution (p < 0.001) that was most evident during puberty. Also, within the period 1999-2010, there were increasing fracture rates per 10(5) and year (boys +2.0% (95% CI: 1.5-2.6), girls +2.4% (95% CI: 1.7-3.1)). Interpretation - The distal forearm fracture rate in children is currently 50% higher than in the 1950s, and it still appears to be increasing. If this higher fracture risk follows the children into old age, numbers of fragility fractures may increase sharply-as an upturn in life expectancy has also been predicted. The origin of the increase remains unknown, but it may be associated with a more sedentary lifestyle or with changes in risk behavior.

Figure 1.

Incidence of distal forearm fractures in girls and boys per 10⁵, in different settings and time periods. ^a Current study. ^b Allfram and Bauer 1962, Landin , Tiderius et al. . ^c Hedström et al. . ^d Khosla et al. . ^e Cooper et al. . ^f Mayranpaa et al. . ^g Wilcke et al. .

Figure 2.

Sex and age class-specific incidence of distal forearm fracture per 10⁵ during different periods in children ≤ 16 years of age in Malmö (1950–1994; Allfram and Bauer 1962, Landin , Tiderius et al. 1999) and in the county of Skåne (1999–2010; current study), in 2-year age class strata.