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Published on: January 29, 2018
Association between bone density and fractures in children: a systematic review and meta-analysis
E M Clark1, J H Tobias, A R Ness
1Department of Community Based Medicine, University of Bristol, Bristol, United Kingdom. emma.clark@bristol.ac.uk
Insights
Low bone density is linked to fractures in children. This systematic review found evidence suggesting an association, though more prospective studies are needed to confirm findings in pediatric bone health.
Area of Science:
- Pediatric Orthopedics
- Bone Metabolism
- Epidemiology
Background:
- Fractures are a common injury in children.
- Understanding risk factors for pediatric fractures is crucial for prevention and management.
- Bone density is a known determinant of fracture risk in adults.
Purpose of the Study:
- To systematically review and synthesize evidence on the association between bone density and fractures in children.
- To determine if lower bone mineral density is a risk factor for fractures in pediatric populations.
Main Methods:
- A systematic literature search was conducted across electronic databases.
- Studies were included if participants were under 16 years old, healthy, and reported bone mass and fracture data.
- A meta-analysis was performed on eight case-control studies using a fixed-effects model.
Main Results:
- Ten case-control studies were identified; no prospective studies were found.
- The meta-analysis revealed a pooled standardized mean difference of -0.32 (95% CI: -0.43 to -0.21) for bone mass in children with fractures compared to controls.
- No significant heterogeneity or funnel-plot asymmetry was detected between the included studies.
Conclusions:
- The current evidence suggests an association between lower bone density and an increased risk of fractures in children.
- The findings are primarily based on case-control studies, which are susceptible to bias.
- High-quality, large-scale prospective cohort studies are recommended to validate these findings and establish causality.
Objective:
The objective of this article was to systematically review all published studies that investigated the association between bone density and fractures in children.
Design:
Potentially relevant articles were identified by searching electronic databases. Duplicates were removed, abstracts were inspected, and relevant articles were obtained. Studies were included in the systematic review if participants were <16.0 years old, were healthy, had extractable data on bone mass, and had fractures as the outcome.
Results:
Ten case-control studies were identified. No prospective studies were found. There was no evidence of heterogeneity between studies or of funnel-plot asymmetry. Eight of the studies were included in the meta-analysis, because they presented results as means and standard deviations of bone density in cases and controls. The pooled standardized mean difference for bone mass in children with and without fractures, from a fixed-effects model, was -0.32 (95% confidence interval: -0.43 to -0.21).
Conclusions:
Evidence for an association between bone density and fractures in children is limited. The results from this meta-analysis suggest that there is an association between low bone density and fractures in children. Although there was no evidence of heterogeneity or publication bias, this meta-analysis is based on case-control studies that are prone to bias. Large, well-conducted prospective cohort studies are required to confirm the association between bone density and fractures in children.
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