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Metabolic bone disease risk factors strongly contributing to long bone and rib fractures during early infancy: A
Ulf Högberg1, Jacob Andersson2, Göran Högberg3
1Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Insights
Infant fractures are linked to metabolic bone disease risk factors, especially in early infancy. Abuse diagnoses in infants with fractures also showed a metabolic bone risk factor profile.
Area of Science:
- Pediatrics
- Orthopedics
- Public Health
Background:
- Fractures in infancy are a significant concern.
- Understanding their causes, including accidents, metabolic bone disease, and abuse, is crucial.
Purpose of the Study:
- To determine the incidence of infant fractures.
- To investigate associations between fractures, accidents, metabolic bone disease risk factors, and abuse diagnoses.
Main Methods:
- Population-based register study in Sweden (1997-2014).
- Included infants (0-1 years) diagnosed with fractures (ICD10).
- Data linked from National Patient Register, Swedish Medical Birth Register, and Death Cause Register.
Main Results:
- Infant fracture incidence was 251 per 100,000.
- Long bone fractures were most common (44.9%), followed by skull (31.7%).
- Metabolic bone disease risk factors (e.g., vitamin D deficiency) significantly increased odds of long bone and rib fractures in early infancy.
Conclusions:
- Metabolic bone disease risk factors are strongly associated with infant fractures, particularly long bone and rib fractures in the first six months.
- Infant fracture cases with abuse diagnoses exhibited a metabolic bone risk factor profile.
Background:
The aim of this study was to assess the incidence of fractures in infancy, overall and by type of fracture, its association with accidents, metabolic bone disease risk factors, and abuse diagnosis.
Methods:
The design was a population-based register study in Sweden. Participants: Children born 1997-2014, 0-1 years of age diagnosed with fracture-diagnosis according to International Classification of Diseases (ICD10) were retrieved from the National Patient Register and linked to the Swedish Medical Birth Register and the Death Cause Register. Main outcome measures were fractures of the skull, long bone, clavicle and ribs, categorized by age (younger or older than 6 months), and accident or not.
Findings:
The incidence of fractures during infancy was 251 per 100 000 infants (n = 4663). Major fracture localisations were long bone (44·9%), skull (31·7%), and clavicle (18·6%), while rib fractures were few (1·4%). Fall accidents were reported among 71·4%. One-third occurred during the first 6 months. Metabolic bone disease risk factors, such as maternal obesity, preterm birth, vitamin D deficiency, rickets, and calcium metabolic disturbances, had increased odds of fractures of long bones and ribs in early infancy (0-6 months): birth 32-36 weeks and long bone fracture [AOR 2·13 (95%CI 1·67-2·93)] and rib fracture [AOR 4·24 (95%CI 1·40-12·8)]. Diagnosis of vitamin D deficiency/rickets/disorders of calcium metabolism had increased odds of long bone fracture [AOR 49·5 (95%CI 18·3-134)] and rib fracture [AOR 617 (95%CI 162-2506)]. Fractures without a reported accident had higher odds of metabolic risk factors than those with reported accidents. Abuse diagnosis was registered in 105 infants, with overrepresentation of preterm births, multiple births and small-for-gestational age.
Interpretation:
Metabolic bone disease risk factors are strongly associated with fractures of long bone and ribs in early infancy. Fracture cases with abuse diagnosis had a metabolic bone risk factor profile.
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