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Appendicular fracture epidemiology of children and adolescents: a 10-year case review in Western Australia (2005 to 2015)

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Abstract

Summary

Fracture incidence data of Australian children and adolescents have not been reported in the literature. A 10-year case review of fracture presentations in Western Australia is provided. Between 2005 and 2015, fracture incidence increased relative to population growth. This is concerning, and interventions are required to reverse this trend.

Purpose

Fracture incidence in 0–16-year-olds is high and varies between countries. Boys have a 1.5:1 ratio of fracture incidence compared to girls. There are no specific data for Australia. Western Australia is a state with unique geography and population distribution having only a single tertiary paediatric hospital (Princess Margaret Hospital, PMH, in Perth) managing the majority of children and adolescents with fractures in the Emergency Department (ED). The aims of this study were to characterise fracture presentations to PMH-ED and compare the incidence to population data.

Methods

A database audit of fracture presentations between 2005 and 2015 for fracture rates with a sub-analysis for gender, fracture site and age and a comparison to Perth Metropolitan and Western Australian population data was performed.

Results

Analysis included 31,340 presentations. Fracture incidence, adjusted for the annual population size, increased from 0.63% in 2005 to 0.85% in 2015 (p < 0.001). The month of May reported the highest fracture rate (p < 0.001) corresponding with the start of the winter sports season. Males had a 1.5 times higher fracture incidence than females (p < 0.001), with upper limb fractures three times more common than lower limb fractures (p < 0.001). Fracture incidence increased with age until the early teenage years (15 years for males; 12 years for females) when a decline occurred.

Conclusions

Increased fracture incidence in Western Australia between 2005 and 2015 identifies a concerning trend for bone health in children and adolescents. Further research is needed to identify potential lifestyle factors that impact fracture incidence translating into evidence-based strategies to reverse these trends and improve bone health.

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Acknowledgements

The authors thank Mr. Dmitry Skarin for handling the queries to the EDIS database.

Funding

Mr. Mark Jenkins is supported by an Australian Government Research Training Program Scholarship. Dr. Nicolas H. Hart is supported by the Cancer Council of Western Australia Postdoctoral Research Fellowship.

Author information

Authors and Affiliations

  1. Centre for Exercise and Sports Science Research, Edith Cowan University, Perth, WA, Australia

    Mark Jenkins & Sophia Nimphius

  2. Western Australian Bone Research Collaboration, Perth, WA, Australia

    Mark Jenkins, Sophia Nimphius, Nicolas H. Hart, Paola Chivers, Timo Rantalainen, Fleur McIntyre & Aris Siafarikas

  3. Institute for Health Research, The University of Notre Dame Australia, Perth, WA, Australia

    Nicolas H. Hart, Paola Chivers, Timo Rantalainen & Aris Siafarikas

  4. Exercise Medicine Research Institute, Edith Cowan University, Building 21, Room 222, 270 Joondalup Drive, Joondalup, Perth, WA, 6027, Australia

    Nicolas H. Hart, Paola Chivers, Timo Rantalainen & Aris Siafarikas

  5. Gerontology Research Centre, University of Jyväskylä, Jyväskylä, Finland

    Timo Rantalainen

  6. Emergency Department, Princess Margaret Hospital, Perth, WA, Australia

    Kristina Rueter & Meredith L. Borland

  7. Medical School, Division of Paediatrics, University of Western Australia, Perth, WA, Australia

    Kristina Rueter, Meredith L. Borland & Aris Siafarikas

  8. Department of Immunology, Princess Margaret Hospital, Perth, WA, Australia

    Kristina Rueter

  9. School of Health Sciences, University of Notre Dame Australia, Perth, WA, Australia

    Fleur McIntyre

  10. Department of Orthopaedic Surgery, Princess Margaret Hospital, Perth, WA, Australia

    Katherine Stannage

  11. Department of Endocrinology and Diabetes, Princess Margaret Hospital, Perth, WA, Australia

    Katherine Stannage & Aris Siafarikas

  12. Telethon Kids Institute for Child Health Research, Perth, WA, Australia

    Aris Siafarikas

Authors
  1. Mark Jenkins
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  2. Sophia Nimphius
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  3. Nicolas H. Hart
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  4. Paola Chivers
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  5. Timo Rantalainen
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  6. Kristina Rueter
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  7. Meredith L. Borland
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  8. Fleur McIntyre
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  9. Katherine Stannage
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  10. Aris Siafarikas
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Contributions

MJ drafted the initial manuscript. MJ, SN, NHH, PC, TR, FM and AS conceptualised the research design and interpreted the results. MJ and PC analysed, and SN and NHH reviewed statistical methods. KR, MLB, KS and AS contributed to data acquisition and interpretation. All authors critically evaluated and approved the final draft.

Corresponding author

Correspondence to Nicolas H. Hart.

Ethics declarations

Ethics approval was obtained from the Princess Margaret Hospital Human Research Ethics Committee (GEKO ID: 12649) for analysis and subsequent publication of the de-identified data.

Conflicts of interest

None.

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Jenkins, M., Nimphius, S., Hart, N.H. et al. Appendicular fracture epidemiology of children and adolescents: a 10-year case review in Western Australia (2005 to 2015). Arch Osteoporos 13, 63 (2018). https://doi.org/10.1007/s11657-018-0478-9

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