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Association of Preterm Birth and Low Birthweight with Bone Fractures during Childhood
Ilari Kuitunen1,2, Reijo Sund3, Ulla Sankilampi1,2
1Institute of Clinical Medicine and Department of Pediatrics, University of Eastern Finland, Kuopio, Finland.
Insights
Children born very preterm or with extremely low birthweight had lower childhood fracture rates than full-term infants. This suggests factors beyond early life events influence fracture incidence in children.
Area of Science:
- Pediatrics
- Orthopedics
- Epidemiology
Background:
- Preterm birth and low birthweight are linked to increased childhood fracture risk.
- Understanding fracture incidence in these populations is crucial for pediatric bone health.
Purpose of the Study:
- To compare childhood bone fracture rates in preterm and low-birthweight newborns versus full-term, normal-birthweight newborns.
- To analyze the timing and incidence of fractures from birth up to 20 years of age.
Main Methods:
- Nationwide register-based cohort study in Finland (1998-2017).
- Inclusion of all newborns alive 28 days post-birth.
- Data collection on fracture visits in specialized healthcare units.
- Calculation of incidences per 100,000 person-years and incidence rate ratios (IRRs).
- Kaplan-Meier analysis for fracture timing.
Main Results:
- Very preterm newborns (<32 weeks) showed a 23% lower fracture incidence (IRR 0.77).
- Preterm newborns (32-36 weeks) had fracture rates similar to term newborns (IRR 0.98).
- Lower birthweight correlated with lower fracture incidence; newborns <1000g had the lowest incidence (773/100,000 person-years).
- Newborns ≥2500g had the highest incidence (966/100,000 person-years).
Conclusions:
- Children born very preterm or with extremely low birthweight generally experience lower childhood fracture incidence.
- Findings may reflect improved neonatal care and nutrition, alongside other factors influencing fracture risk.
- Childhood fracture incidence appears more dependent on factors beyond early life events.
Abstract:
Preterm birth and low birthweight have been associated with increased fracture risk in children. Our aim was to analyze bone fractures during childhood in preterm, and low-birthweight newborns compared to full-term and normal-birthweight newborns. We conducted a nationwide register-based cohort study in Finland from 1998 to 2017 and utilized the Medical Birth Register and Care Register for Health Care. All newborns alive 28 days after birth were included, and data on all fracture visits in specialized healthcare units were gathered. Incidences per 100,000 person-years with 95% confidence intervals (CI) were calculated, and comparisons were made by incidence rate ratios (IRRs). Kaplan-Meier analysis was used to analyze the timing of fractures during childhood (0-20 years). We included a total of 997,468 newborns and 95,869 fractures; the mean follow-up was 10.0 years, and the overall incidence of fractures was 963 per 100,000 person-years. Very preterm (<32 gestational weeks) newborns had 23% lower fracture incidence than term newborns (IRR 0.77; CI: 0.70-0.85). Preterm newborns (32 to 36 gestational weeks) had a fracture rate (IRR 0.98; CI: 0.95-1.01) similar to that of term newborns. Birthweight showed a linear increase in the fracture rates as newborns with birthweight less than 1000 g had the lowest fracture incidence of 773 per 100,000 person-years and the highest incidence (966 per 100,000 person-years) was among newborns with birthweight 2500 g or more. Children born very preterm or with extremely low birthweight have in general a lower fracture incidence during childhood compared to children born full term and with normal birthweight. These findings possibly reflect, in addition to improvements of neonatal intensive care and early nutrition, the fact that childhood fracture incidences are more dependent on issues other than early life events. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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