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Is there an association between birth characteristics and fractures in young adults? The HUNT Study, Norway
Hilde Thomasli Holltrø1,2, T I L Nilsen3, B Schei3,4
1Department of Neuromedicine and Movement Science, NTNU - Norwegian University of Science and Technology, Trondheim, Norway. Hilde.t.holltro@ntnu.no.
Insights
Birth characteristics like birth weight and gestational age do not appear to influence fracture risk in young adults. This study found no significant association between these factors and fractures of the wrist, humerus, hip, or spine.
Area of Science:
- Orthopedics
- Epidemiology
- Developmental Biology
Background:
- Skeletal development begins in fetal life, with significant bone formation occurring in the third trimester.
- Understanding early life influences on bone health is crucial for long-term skeletal integrity.
Purpose of the Study:
- To investigate the association between birth characteristics (birth weight, gestational age, birth weight for gestational age) and the risk of fractures in young adults.
- To examine fractures of the wrist, humerus, hip, and spine in individuals aged 19-54 years.
Main Methods:
- A population-based study involving 11,099 participants from the HUNT Study, linked with the Medical Birth Registry of Norway.
- Fracture data (ICD9/10 codes) were collected between 1988 and 2021, with follow-up until fracture, emigration, death, or study end.
- Cox regression analysis was used to estimate hazard ratios (HR) for fracture risk associated with birth characteristics, adjusted for covariates.
Main Results:
- A median follow-up of 14.0 years revealed 290 fractures among participants.
- No clear associations were found between birth weight, gestational age, or birth weight for gestational age and the risk of wrist, humerus, hip, or spine fractures.
- Hazard ratios for low birth weight, being small for gestational age, and preterm birth showed no statistically significant increased fracture risk.
Conclusions:
- Birth weight, gestational age, and birth weight for gestational age are not associated with an increased risk of major fractures in young adulthood.
- These findings suggest that early life growth parameters may not be critical determinants of fracture susceptibility later in life.
Abstract:
This population study investigated the association between birth characteristics and fracture risk in 11,099 young adults (aged 19-54 years). Our findings indicate that birth weight, gestational age, and birth weight for gestational age were not associated with fractures in the wrist, humerus, hip, and spine in this population.
Purpose:
Skeletal development starts during fetal life, and it is estimated that most bone formation occurs in the 3rd trimester. This study examined the association between birth characteristics and fractures of the wrist, humerus, hip, and spine, in young adults (19-54 years).
Methods:
11.099 participants in the 3rd survey of the HUNT Study (2006-2008) were linked with the Medical Birth Registry of Norway and hospital records. Fractures of the wrist, humerus, hip, and spine were identified using ICD9/10 codes between 1988 and 2021. Follow-up was from date of participation in HUNT until a first fracture, emigration, death, or end of study. Cox regression was used to estimate hazard ratios (HR) of fracture associated with birth characteristics (95% CI), adjusted for birth year, sex, maternal age, and maternal morbidity. In a secondary analysis, follow-up started in 1988.
Results:
During a median follow-up of 14.0 years (153,657 person-years), 290 fractures occurred. Mean age at first fracture was 41.4 years (SD 7.4). Overall, there were no clear associations between birth characteristics and fractures in these data. HR for fracture was 0.43 (0.15-1.24) for those with a birth weight < 2.5 kg (reference birth weight 3.5 - 3.9 kg); 1.04 (0.74 - 1.46) for those born small for gestational age (< 10th percentile, reference 10 - 90th percentile); and 0.63 (0.33 - 1.23) for those born preterm (reference term births). The secondary analysis from 1988, including 539 fractures, gave similar results as the main analysis.
Conclusion:
Birth weight, gestational age, or birth weight for gestational age was not associated with an increased risk of fractures of the wrist, humerus, hip, and spine in young adults.
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