Racial disparity in fracture risk between white and nonwhite children in the United States

Tishya A L Wren, John A. Shepherd, Heidi J. Kalkwarf, Babette S. Zemel, Joan M. Lappe, Sharon Oberfield, Frederick J. Dorey, Karen K. Winer, Vicente Gilsanz

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Objectives: To examine risk factors for fracture in a racially diverse cohort of healthy children in the US. Study design: A total of 1470 healthy children, aged 6-17 years, underwent yearly evaluations of height, weight, body mass index, skeletal age, sexual maturation, calcium intake, physical activity levels, and dual-energy x-ray absorptiometry (DXA) bone and fat measurements for up to 6 years. Fracture information was obtained at each annual visit, and risk factors for fracture were examined using the time-dependent Cox proportional hazards model. Results: The overall fracture incidence was 0.034 fracture per person-year with 212 children reporting a total of 257 fractures. Being white (hazard ratio [HR] = 2.1), being male (HR = 1.8), and having skeletal age of 10-14 years (HR = 2.2) were the strongest risk factors for fracture (all P ≤ .001). Increased sports participation (HR = 1.4), lower body fat percentage (HR = 0.97), and previous fracture in white girls (HR = 2.1) were also significant risk factors (all P ≤ .04). Overall, fracture risk decreased with higher DXA z scores, except in white boys, who had increased fracture risk with higher DXA z scores (HR = 1.7, P <.001). Conclusions: Boys and girls of European descent had double the fracture risk of children from other backgrounds, suggesting that the genetic predisposition to fractures seen in elderly adults also manifests in children.

Original languageEnglish
JournalJournal of Pediatrics
Volume161
Issue number6
DOIs
StatePublished - Dec 2012

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X-Rays
Sexual Maturation
Genetic Predisposition to Disease
Proportional Hazards Models
Sports
Adipose Tissue
Body Mass Index
Fats
Exercise
Calcium
Weights and Measures
Bone and Bones
Incidence

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

Wren, T. A. L., Shepherd, J. A., Kalkwarf, H. J., Zemel, B. S., Lappe, J. M., Oberfield, S., ... Gilsanz, V. (2012). Racial disparity in fracture risk between white and nonwhite children in the United States. Journal of Pediatrics, 161(6). https://doi.org/10.1016/j.jpeds.2012.07.054

Racial disparity in fracture risk between white and nonwhite children in the United States. / Wren, Tishya A L; Shepherd, John A.; Kalkwarf, Heidi J.; Zemel, Babette S.; Lappe, Joan M.; Oberfield, Sharon; Dorey, Frederick J.; Winer, Karen K.; Gilsanz, Vicente.

In: Journal of Pediatrics, Vol. 161, No. 6, 12.2012.

Research output: Contribution to journalArticle

Wren, TAL, Shepherd, JA, Kalkwarf, HJ, Zemel, BS, Lappe, JM, Oberfield, S, Dorey, FJ, Winer, KK & Gilsanz, V 2012, 'Racial disparity in fracture risk between white and nonwhite children in the United States', Journal of Pediatrics, vol. 161, no. 6. https://doi.org/10.1016/j.jpeds.2012.07.054
Wren, Tishya A L ; Shepherd, John A. ; Kalkwarf, Heidi J. ; Zemel, Babette S. ; Lappe, Joan M. ; Oberfield, Sharon ; Dorey, Frederick J. ; Winer, Karen K. ; Gilsanz, Vicente. / Racial disparity in fracture risk between white and nonwhite children in the United States. In: Journal of Pediatrics. 2012 ; Vol. 161, No. 6.
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