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5-year fracture risk among children with cerebral palsy
1Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA. dgwhit@umich.edu.
Insights
Children with cerebral palsy (CP) face higher fracture risks in certain areas like the spine and hips as they grow. This study details age-specific fracture risks to guide prevention strategies for pediatric CP patients.
Area of Science:
- Pediatric Orthopedics
- Epidemiology
- Child Neurology
Background:
- Fracture risk in children with cerebral palsy (CP) throughout growth remains under-documented, hindering timely prevention strategies.
- Lack of age-specific epidemiologic data for pediatric CP fractures limits clinical decision-making.
Purpose of the Study:
- To characterize the 5-year fracture risk by age in children with CP.
- To identify patient-level factors influencing fracture risk in pediatric CP.
Main Methods:
- Retrospective cohort study using commercial administrative claims (2001-2018).
- Included children aged 1-13 years with at least 5 years of insurance enrollment.
- Fracture risk assessed over a 5-year follow-up using Cox regression for CP cohort.
Main Results:
- Children with CP exhibited higher 5-year fracture risk at the vertebral column, hip, and lower extremities compared to controls.
- Elevated fracture risk in CP patients was linked to co-occurring neurological conditions and non-ambulatory status.
- Males with CP showed higher upper extremity fracture risk after age 6.
Conclusions:
- This study provides novel, age-specific epidemiologic data on fracture risk in children with CP.
- Findings highlight the need for targeted fracture prevention strategies based on age and specific risk factors in pediatric CP.
- Results can aid in identifying at-risk children and optimizing intervention timing.
Background:
Epidemiologic evidence documenting fracture risk as children with cerebral palsy (CP) age throughout growth is lacking to inform on when to implement fracture prevention strategies. The objective was to characterize the 5-year risk of fractures by each year of age among <1-13 year olds with CP and effects by patient-level factors.
Methods:
This retrospective cohort study used commercial administrative claims from 01/01/2001 to 12/31/2018 from children <1-13 years old with ≥5 years of insurance enrollment. Fractures were examined during the 5-year follow-up. For the CP cohort, the association between 5-year fracture rate and patient-level factors was assessed using Cox regression.
Results:
Children with (n = 5559) vs. without (n = 2.3 million) CP had a higher 5-year fracture risk at the vertebral column, hip, and lower extremities at almost each year of age, but lower 5-year fracture risk at the upper extremities after 6 years old (all P < 0.05). Among children with CP, the 5-year fracture rate was elevated for co-occurring neurological conditions and non-ambulatory status at the vertebral column, hip, and lower extremities (hazard ratio [HR] range, 1.44-2.39), and higher for males at the upper extremities (HR = 1.29) (all P < 0.05).
Conclusions:
This study provides novel epidemiologic evidence of 5-year fracture risk for each year of age for children with CP.
Impact:
This study provides novel epidemiologic evidence of 5-year fracture risk for each year of age across important developmental stages for children with vs. without cerebral palsy (CP). Children with vs. without CP were more likely to fracture at the vertebral column, hip, lower extremities, and humerus and less likely to fracture at the forearm and hands. The age-related 5-year fracture risk was associated with clinically relevant patient-level factors, but in different ways by fracture region. Study findings may be used to enhance clinical detection of at-risk children and strategize when to implement fracture prevention efforts for children with CP.
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