Archives of Osteoporosis

, 14:9 | Cite as

An epidemiological evaluation of fractures and its determinants among Lebanese schoolchildren: a cross-sectional study

  • Nada Younes
  • Marie-Ange El Hajj
  • Aren Joe Bizdikian
  • Marie-Hélène Gannagé-YaredEmail author
Original Article



The purpose of this study is to establish the prevalence and determinants of fractures among 974 Lebanese schoolchildren aged 8–18. Fractures might be less common in the Lebanese pediatric population compared to western populations. Male gender and high SES are independent risk factors for fractures, while 25(OH)D and BMI have no impact.


To establish the prevalence of fractures among Lebanese schoolchildren and its relationship with age, gender, BMI, 25 hydroxyvitamin D (25(OH)D) levels, and socioeconomic status (SES).


In this cross-sectional study, 974 Lebanese schoolchildren aged 8–18 years old, mean age 13.37 ± 2.92 (508 boys and 466 girls), were recruited from 10 schools with different SES. For each participant, a questionnaire was used to collect data regarding history of fractures. Serum 25(OH)D was also measured.


The prevalence of Lebanese children sustaining ≥ 1 fracture was 16.9% and was higher in boys compared to girls (22.2% vs 11.1%, p < 0.0001). A 71.3% of fractures were localized in the upper limbs and 20% of participants had at least one displaced fracture. Children who sustained a fracture had a non-significant higher BMI compared to those without (p = 0.096). The percentage of children with fractures was higher in children from high SES compared to those from middle and low SES (respectively 23.3% vs. 16.3% and 13.8%, p < 0.0001). Fractures occurred at a younger age in girls compared to boys, but this difference was non-significant (p = 0.13). 25(OH)D levels were significantly higher in children with fractures compared to those without (p = 0.017). Finally, female gender was protective against upper limb fractures (p = 0.009). In a logistic regression analysis, male gender and high SES were independently associated with fractures, while BMI and 25(OH)D were not.


Our study demonstrates that the prevalence of fractures in the Lebanese pediatric population might be lower than western populations. It also confirms that male gender and high SES are independent risk factors for fractures, while 25(OH)D and BMI were not independently associated with fracture risk.


Fractures Lebanese Schoolchildren 



Body Mass Index (BMI),


25 hydroxyvitamin D


socioeconomic status.


Authors’ contributions

NY and MA performed the data collection and participate to the writing of the manuscript. AJB performed the statistical analysis and interpreted the results. MHG designed the study, got the funding, and participate to the writing the manuscript. All authors read and approved the final manuscript.


Conseil de la recherche de l’Université Saint-Joseph” (FM249), Beirut, Lebanon and Pharmaline Laboratories Lebanon.

Compliance with ethical standards

Conflict of interest


Ethics approval and consent to participate

The study was approved by the Ethics Committee of our hospital (Reference number CEHDF449) and Informed consent was signed by the children’s parents.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  • Nada Younes
    • 1
  • Marie-Ange El Hajj
    • 1
  • Aren Joe Bizdikian
    • 1
  • Marie-Hélène Gannagé-Yared
    • 1
    Email author
  1. 1.Division of Endocrinology, Hotel-Dieu de France HospitalSaint-Joseph UniversityBeirutLebanon

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